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General NPI Number Information
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NPI Number | 1790188126
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Entity Type | Organization
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Legal Business Name | HI-TECH DENTAL ARTS
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Dates
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Enumeration Date | 09/30/2014
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Last Update Date | 09/30/2014
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Provider Practice Location Address
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Address Line | 386 NORTHAMPTON ST
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City | EDWARDSVILLE
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State | PA
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Zip | 18704-5448
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Country | US
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Telephone | 148-441-0420
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Fax |
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Provider Business Mailing Address
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Address Line | 386 NORTHAMPTON ST
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City | EDWARDSVILLE
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State | PA
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Zip | 18704-5448
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Country | US
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Telephone | 148-441-0420
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRUCE ROSEN
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Credential |
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Telephone | 14844104200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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