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General NPI Number Information
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NPI Number | 1699127563
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Entity Type | Organization
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Legal Business Name | SWARTHMORE DENTAL ASSOCIATES, LLC
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Dates
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Enumeration Date | 07/05/2016
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Last Update Date | 07/05/2016
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Provider Practice Location Address
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Address Line | 801 YALE AVE SUITE 619
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City | SWARTHMORE
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State | PA
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Zip | 19081-1808
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Country | US
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Telephone | 610-328-4817
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Fax |
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Provider Business Mailing Address
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Address Line | 801 YALE AVE SUITE 619
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City | SWARTHMORE
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State | PA
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Zip | 19081-1808
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Country | US
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Telephone | 610-328-4817
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Fax |
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Authorized Official
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Title or Position | PERIODONTIST/PRESIDENT
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Name | DR. LAURA MINSK
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Credential | D.M.D.
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Telephone | 610-328-4815
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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 | DS029928L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DS028124L
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License Number State | PA
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