=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861908303
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BUCKS DENTAL ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/20/2017
-----------------------------------------------------
Last Update Date | 04/08/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4 MEADOWBROOK LN
-----------------------------------------------------
City | CHALFONT
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18914-2811
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-997-5550
-----------------------------------------------------
Fax | 215-997-3375
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4 MEADOWBROOK LN
-----------------------------------------------------
City | CHALFONT
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18914-2811
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-997-5550
-----------------------------------------------------
Fax | 215-997-3375
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | STEPHANIE HUPRICH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 215-997-5550
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------