MEDICARE: TRANSCEND DENTAL LLC

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	1223P0300X	Periodontics	DS037420	PA

General Provider Information

NPI Number	:	1063709897
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRANSCEND DENTAL LLC

Provider Business Mailing Address
First Line	:	70 BUCKWALTER RD
Second Line	:	SUITE 309
City	:	ROYERSFORD
State	:	PA
Zip	:	19468-1846
Country	:	US
Telephone Number	:	610-616-3641
Fax Number	:

Provider Business Practice Location Address
First Line	:	70 BUCKWALTER RD
Second Line	:	SUITE 309
City	:	ROYERSFORD
State	:	PA
Zip	:	19468-1846
Country	:	US
Telephone Number	:	610-616-3641
Fax Number	:

Authorized Official
Title or Position	:	PERIODONTIST
Name	:	SAMER KHOURY
Credential	:	DDS MS
Telephone Number	:	610-616-3641

Provider Enumeration Date	:	06/30/2011
Last Update Date	:	06/30/2011

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