MEDICARE: DR. JOSEPH FUNARI DMD

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	DS042333	PA
2	1223G0001X	General Practice Dentistry	DS042333	PA

General Provider Information

NPI Number	:	1326600628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH FUNARI DMD

Provider Business Mailing Address
First Line	:	4101 MAIN ST
Second Line	:
City	:	ELVERSON
State	:	PA
Zip	:	19520-9378
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4101 MAIN ST
Second Line	:
City	:	ELVERSON
State	:	PA
Zip	:	19520-9378
Country	:	US
Telephone Number	:	610-286-5841
Fax Number	:

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

Provider Enumeration Date	:	07/08/2019
Last Update Date	:	12/02/2020

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