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General NPI Number Information
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NPI Number | 1841454030
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Entity Type | Organization
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Legal Business Name | JOHN T. WAITE, D.D.S.
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Dates
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Enumeration Date | 07/16/2008
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Last Update Date | 07/16/2008
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Provider Practice Location Address
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Address Line | 282 N LANSDOWNE AVE
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City | LANSDOWNE
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State | PA
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Zip | 19050-1101
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Country | US
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Telephone | 610-394-3363
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Fax | 610-259-7785
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Provider Business Mailing Address
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Address Line | 282 N LANSDOWNE AVE
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City | LANSDOWNE
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State | PA
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Zip | 19050-1101
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Country | US
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Telephone | 610-394-3363
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Fax | 610-259-7785
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN T. WAITE
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Credential | D.D.S.
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Telephone | 610-394-3363
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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 | DS026358L
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License Number State | PA
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