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General NPI Number Information
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NPI Number | 1942665377
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Entity Type | Organization
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Legal Business Name | COMPLETE DENTAL SOLUTION OF LIMERICK LLC
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Dates
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Enumeration Date | 12/30/2015
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Last Update Date | 12/30/2015
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Provider Practice Location Address
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Address Line | 292 W RIDGE PIKE BUILDING B, 2ND FL
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City | LIMERICK
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State | PA
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Zip | 19468-3716
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Country | US
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Telephone | 610-308-6609
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Fax |
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Provider Business Mailing Address
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Address Line | 292 W.RIDGE PIKE BUILDING B, 2ND FL
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City | LIMERICK
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State | PA
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Zip | 19468
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. THOMAS C WATSON
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Credential | DMD
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Telephone | 610-308-6609
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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 | DS027446-L
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License Number State | PA
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