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General NPI Number Information
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NPI Number | 1932556925
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Entity Type | Organization
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Legal Business Name | ARDMORE PEDIATRIC DENTAL ASSOCIATES PC
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Dates
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Enumeration Date | 05/19/2016
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Last Update Date | 05/19/2016
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Provider Practice Location Address
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Address Line | 233 E LANCASTER AVE SUITE 201
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City | ARDMORE
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State | PA
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Zip | 19003-2321
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Country | US
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Telephone | 610-896-8300
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Fax |
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Provider Business Mailing Address
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Address Line | 596 LANCASTER AVE SUITE 101
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City | MALVERN
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State | PA
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Zip | 19355-1808
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Country | US
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Telephone | 484-679-4071
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JAY GOLDSLEGER
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Credential | DMD
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Telephone | 610-896-8300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DS020687L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DS018777L
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License Number State | PA
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