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General NPI Number Information
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NPI Number | 1578016689
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Entity Type | Organization
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Legal Business Name | PEDIATRIC DENTISTRY OF READING P.C.
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Dates
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Enumeration Date | 07/26/2016
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Last Update Date | 07/26/2016
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Provider Practice Location Address
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Address Line | 5001 PERKIOMEN AVE SUITE 101
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City | READING
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State | PA
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Zip | 19606-9614
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Country | US
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Telephone | 484-334-2310
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Fax | 484-334-2311
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Provider Business Mailing Address
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Address Line | 5001 PERKIOMEN AVE SUITE 101
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City | READING
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State | PA
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Zip | 19606-9614
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Country | US
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Telephone | 484-334-2310
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Fax | 484-334-2311
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | BETHANY GRATSON
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Credential | D.M.D.
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Telephone | 724-601-6951
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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 | DS038715
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License Number State | PA
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