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General NPI Number Information
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NPI Number | 1538503115
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Entity Type | Organization
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Legal Business Name | JUSTA FARM DENTAL ASSOCIATES
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Dates
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Enumeration Date | 04/25/2013
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Last Update Date | 04/25/2013
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Provider Practice Location Address
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Address Line | 1946 COUNTY LINE RD
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City | HUNTINGDON VALLEY
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State | PA
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Zip | 19006-1738
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Country | US
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Telephone | 215-322-8711
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Fax | 215-322-8789
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Provider Business Mailing Address
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Address Line | 1946 COUNTY LINE RD
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City | HUNTINGDON VALLEY
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State | PA
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Zip | 19006-1738
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Country | US
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Telephone | 215-322-8711
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Fax | 215-322-8789
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Authorized Official
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Title or Position | OWNER
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Name | DR. LEONARD JAY FISHMAN
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Credential | DMD, FAGD
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Telephone | 215-322-8711
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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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