MEDICARE: BEDFORD DENTAL HEALTH CENTER 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	1223G0001X	General Practice Dentistry	DS041066	PA

General Provider Information

NPI Number	:	1679023741
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEDFORD DENTAL HEALTH CENTER LLC

Provider Business Mailing Address
First Line	:	403 S JULIANA ST
Second Line	:
City	:	BEDFORD
State	:	PA
Zip	:	15522-1825
Country	:	US
Telephone Number	:	814-623-8747
Fax Number	:

Provider Business Practice Location Address
First Line	:	403 S JULIANA ST
Second Line	:
City	:	BEDFORD
State	:	PA
Zip	:	15522-1825
Country	:	US
Telephone Number	:	814-623-8747
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DIANE ROMAINE
Credential	:	DMD
Telephone Number	:	240-580-0277

Provider Enumeration Date	:	10/12/2016
Last Update Date	:	10/12/2016

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