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General NPI Number Information
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NPI Number | 1710236526
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Entity Type | Organization
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Legal Business Name | WILLIAM PENN DENTAL CENTER
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Dates
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Enumeration Date | 09/07/2012
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Last Update Date | 09/07/2012
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Provider Practice Location Address
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Address Line | 701 VILLAGE AT STONES CROSSING RD 701 VILLAGE AT STONES CROSSING ROAD
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City | EASTON
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State | PA
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Zip | 18045-5081
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Country | US
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Telephone | 610-258-2000
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Fax | 610-258-2400
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Provider Business Mailing Address
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Address Line | 701 VILLAGE AT STONES CROSSING RD 701 VILLAGE AT STONES CROSSING ROAD
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City | EASTON
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State | PA
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Zip | 18045-5081
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Country | US
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Telephone | 610-258-2000
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Fax | 610-258-2400
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Authorized Official
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Title or Position | GENERAL DENTIST
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Name | DR. MATTHEW GHADAMI
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Credential | D.D.S.
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Telephone | 610-258-2000
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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 | DS038126
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License Number State | PA
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