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General NPI Number Information
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NPI Number | 1437269008
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Entity Type | Organization
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Legal Business Name | LEHIGH VALLEY SUBURBAN DENTAL ASSOC LTD
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1621 N CEDARCREST BLVD SUITE 117
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City | ALLENTOWN
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State | PA
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Zip | 18104
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Country | US
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Telephone | 610-820-9900
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Fax | 610-820-9922
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Provider Business Mailing Address
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Address Line | 1621 N CEDARCREST BLVD SUITE 117
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City | ALLENTOWN
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State | PA
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Zip | 18104
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Country | US
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Telephone | 610-820-9900
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Fax | 610-820-9922
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Authorized Official
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Title or Position | PARTNER MANAGER
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Name | DR. MARK B DIAMOND
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Credential | DMD
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Telephone | 610-820-9900
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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 | DS017121L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DS019952L
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DS022795L
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License Number State | PA
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Taxonomy #4
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DS020511L
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License Number State | PA
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