MEDICARE: HAVERFORD DENTAL P.C.

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	DS027078L	PA

General Provider Information

NPI Number	:	1053541474
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAVERFORD DENTAL P.C.

Provider Business Mailing Address
First Line	:	1215 GULPH CREEK DR
Second Line	:
City	:	RADNOR
State	:	PA
Zip	:	19087-4687
Country	:	US
Telephone Number	:	215-477-8800
Fax Number	:	215-477-8800

Provider Business Practice Location Address
First Line	:	1025 N 66TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19151-3104
Country	:	US
Telephone Number	:	215-477-8800
Fax Number	:	215-477-8800

Authorized Official
Title or Position	:	ONWER/ DENTIST
Name	:	DR. VICKY CHANG ARTHUR
Credential	:	D.D.S
Telephone Number	:	215-477-8800

Provider Enumeration Date	:	07/20/2009
Last Update Date	:	08/12/2009

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