MEDICARE: AMDENT LTD

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

General Provider Information

NPI Number	:	1568731784
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMDENT LTD

Provider Business Mailing Address
First Line	:	1301 PENN AVE
Second Line	:
City	:	WYOMISSING
State	:	PA
Zip	:	19610-2140
Country	:	US
Telephone Number	:	610-372-6313
Fax Number	:

Provider Business Practice Location Address
First Line	:	5106 ALLENTOWN PIKE
Second Line	:
City	:	TEMPLE
State	:	PA
Zip	:	19560-1212
Country	:	US
Telephone Number	:	610-929-9700
Fax Number	:

Authorized Official
Title or Position	:	OPERATIONS MANAGER
Name	:	SHANNON PETERS
Credential	:
Telephone Number	:	610-372-6693

Provider Enumeration Date	:	12/16/2011
Last Update Date	:	01/12/2012

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Directions to “AMDENT LTD ” Practice Location

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