MEDICARE: BEDFORD DENTAL PROFESSIONAL CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DS020764L	PA

General Provider Information

NPI Number	:	1033190640
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEDFORD DENTAL PROFESSIONAL CORP

Provider Business Mailing Address
First Line	:	902 ECHO VALE DR
Second Line	:
City	:	BEDFORD
State	:	PA
Zip	:	15522
Country	:	US
Telephone Number	:	814-623-2217
Fax Number	:	814-623-6271

Provider Business Practice Location Address
First Line	:	902 ECHO VALE DR
Second Line	:
City	:	BEDFORD
State	:	PA
Zip	:	15522
Country	:	US
Telephone Number	:	814-623-2217
Fax Number	:	814-623-6271

Authorized Official
Title or Position	:	PRESIDENT CORP
Name	:	DR. WILLIAM MICHAEL STIFFLER
Credential	:	DDS
Telephone Number	:	814-623-2217

Provider Enumeration Date	:	11/10/2005
Last Update Date	:	08/22/2020

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