MEDICARE: DONNA L ENDY D.M.D.

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	035484	PA

General Provider Information

NPI Number	:	1316004567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA L ENDY D.M.D.

Provider Business Mailing Address
First Line	:	1402 W BROAD ST
Second Line	:
City	:	QUAKERTOWN
State	:	PA
Zip	:	18951-1110
Country	:	US
Telephone Number	:	215-536-7705
Fax Number	:	215-536-7740

Provider Business Practice Location Address
First Line	:	1500 LOCUST ST
Second Line	:	SUITE 1408
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-4329
Country	:	US
Telephone Number	:	215-732-4450
Fax Number	:	215-735-9886

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	04/20/2018

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