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General NPI Number Information
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NPI Number | 1558895888
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Entity Type | Organization
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Legal Business Name | DMD ENDEAVORS
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Dates
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Enumeration Date | 04/13/2017
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Last Update Date | 04/17/2017
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Provider Practice Location Address
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Address Line | 111 FORREST AVE 2ND FLOOR
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City | NARBERTH
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State | PA
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Zip | 19072
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Country | US
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Telephone | 215-588-1260
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Fax |
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Provider Business Mailing Address
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Address Line | 111 FORREST AVE 2ND FLOOR
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City | NARBERTH
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State | PA
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Zip | 19072
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Country | US
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Telephone | 215-749-0090
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DAVID DANISH
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Credential | MD
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Telephone | 215-749-0090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD 438014
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License Number State | PA
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