=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982914875
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | READING HYBRIDGE, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/14/2010
-----------------------------------------------------
Last Update Date | 10/14/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1008 BEN FRANKLIN HWY W
-----------------------------------------------------
City | DOUGLASSVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19518-1035
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-385-0703
-----------------------------------------------------
Fax | 610-385-4995
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1008 BEN FRANKLIN HWY W
-----------------------------------------------------
City | DOUGLASSVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19518-1035
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-385-0703
-----------------------------------------------------
Fax | 610-385-4995
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE-PRESIDENT
-----------------------------------------------------
Name | DR. SHAWN HABAKUS
-----------------------------------------------------
Credential | D.M.D.
-----------------------------------------------------
Telephone | 610-385-0703
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | DS029070L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------