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General NPI Number Information
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NPI Number | 1538564265
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Entity Type | Organization
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Legal Business Name | TWIN RIVERS DENTAL
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Dates
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Enumeration Date | 10/23/2014
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Last Update Date | 10/23/2014
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Provider Practice Location Address
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Address Line | 2762 NAZARETH RD
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City | EASTON
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State | PA
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Zip | 18045-2717
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Country | US
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Telephone | 610-253-4227
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Fax |
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Provider Business Mailing Address
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Address Line | 431 HAINES MILL RD
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City | ALLENTOWN
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State | PA
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Zip | 18104-5940
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MRS. MELISSA DUGAN
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Credential |
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Telephone | 484-809-5167
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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 | PA
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