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General NPI Number Information
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NPI Number | 1528325008
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Entity Type | Organization
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Legal Business Name | EAGLE FAMILY DENTISTRY, LLC
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Dates
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Enumeration Date | 04/20/2012
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Last Update Date | 04/20/2012
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Provider Practice Location Address
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Address Line | 72 POTTSTOWN PIKE SUITE 203
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City | CHESTER SPRINGS
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State | PA
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Zip | 19425-9564
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Country | US
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Telephone | 610-458-5165
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Fax |
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Provider Business Mailing Address
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Address Line | 72 POTTSTOWN PIKE SUITE 203
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City | CHESTER SPRINGS
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State | PA
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Zip | 19425-9564
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Country | US
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Telephone | 610-458-5165
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MIRA DELLA CROCE
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Credential | D.M.D.
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Telephone | 215-200-7883
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State | PA
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