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General NPI Number Information
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NPI Number | 1992526586
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Entity Type | Organization
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Legal Business Name | EPP PENNSYLVANIA PLLC
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Dates
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Enumeration Date | 10/17/2024
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Last Update Date | 10/17/2024
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Provider Practice Location Address
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Address Line | 1220 VALLEY FORGE RD STE 40
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City | PHOENIXVILLE
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State | PA
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Zip | 19460-2676
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Country | US
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Telephone | 610-917-9984
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1584
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City | BRENTWOOD
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State | TN
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Zip | 37024-1584
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Country | US
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Telephone | 315-450-0763
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | JASON BERTOLLINI
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Credential |
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Telephone | 315-450-0763
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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