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General NPI Number Information
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NPI Number | 1407962681
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Entity Type | Organization
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Legal Business Name | RICHARD E DEFORNO DMD PC
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Dates
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Enumeration Date | 08/21/2006
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Last Update Date | 07/11/2008
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Provider Practice Location Address
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Address Line | 3105 C G ZINN RD
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City | THORNDALE
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State | PA
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Zip | 19372
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Country | US
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Telephone | 610-384-2541
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Fax | 610-384-8638
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Provider Business Mailing Address
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Address Line | 3105 C G ZINN RD
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City | THORNDALE
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State | PA
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Zip | 19372
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Country | US
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Telephone | 610-384-2541
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Fax | 610-384-8638
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RICHARD E DEFORNO
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Credential | DMD
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Telephone | 610-384-2541
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DS019463
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License Number State | PA
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