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General NPI Number Information
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NPI Number | 1962730689
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Entity Type | Organization
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Legal Business Name | DENTAL HEALTH ASSOCIATES, LTD.
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Dates
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Enumeration Date | 11/19/2009
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Last Update Date | 11/19/2009
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Provider Practice Location Address
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Address Line | 45 DARBY RD
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City | PAOLI
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State | PA
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Zip | 19301-1475
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Country | US
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Telephone | 610-647-7272
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Fax | 610-647-7278
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Provider Business Mailing Address
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Address Line | 45 DARBY RD
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City | PAOLI
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State | PA
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Zip | 19301-1475
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Country | US
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Telephone | 610-647-7272
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Fax | 610-647-7278
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN PATRICK ROEDER
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Credential | D.M.D.
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Telephone | 610-647-7272
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DS030929L
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License Number State | PA
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