=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932057668
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PA PEDIATRIC DENTISTRY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/18/2026
-----------------------------------------------------
Last Update Date | 03/18/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 476 N SUMNEYTOWN PIKE SUITE 320
-----------------------------------------------------
City | NORTH WALES
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19454-2509
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 445-400-5601
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 476 N SUMNEYTOWN PIKE SUITE 320
-----------------------------------------------------
City | NORTH WALES
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19454-2509
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 445-400-5601
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. DANIELLE LOCKWOOD
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 610-442-0640
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------