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General NPI Number Information
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NPI Number | 1497085286
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Entity Type | Organization
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Legal Business Name | NEWTOWN SQUARE DENTAL ASSOCIATES, LLC
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Dates
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Enumeration Date | 12/30/2009
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Last Update Date | 12/30/2009
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Provider Practice Location Address
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Address Line | 28 ALPHA DR
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City | NEWTOWN SQUARE
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State | PA
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Zip | 19073-4102
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Country | US
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Telephone | 610-359-1660
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Fax | 610-359-1662
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Provider Business Mailing Address
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Address Line | 28 ALPHA DR
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City | NEWTOWN SQUARE
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State | PA
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Zip | 19073-4102
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Country | US
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Telephone | 610-359-1660
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Fax | 610-359-1662
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | CHARLES J ROSE
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Credential | DMD
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Telephone | 610-359-1660
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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 |
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License Number State |
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