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General NPI Number Information
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NPI Number | 1932301793
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Entity Type | Organization
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Legal Business Name | FAMILY DENTAL ASSOCIATES PC
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Dates
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Enumeration Date | 06/04/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | STATION SQUARE II
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City | PAOLI
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State | PA
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Zip | 19301
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Country | US
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Telephone | 610-644-1502
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Fax | 610-296-7915
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Provider Business Mailing Address
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Address Line | STATION SQUARE II
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City | PAOLI
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State | PA
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Zip | 19301
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Country | US
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Telephone | 610-644-1502
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Fax | 610-296-7915
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Authorized Official
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Title or Position | PRESIDENT DENTIST
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Name | DR. MARTIN BARRY MOSKOWITZ
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Credential | DMD
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Telephone | 610-644-1502
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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 | PA
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