MEDICARE: MJP FAMILY 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	261QD0000X	Dental Clinic/Center	DS041249	PA

General Provider Information

NPI Number	:	1689179210
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MJP FAMILY DENTAL LLC

Provider Business Mailing Address
First Line	:	3411 W QUEEN LN
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19129-1440
Country	:	US
Telephone Number	:	215-480-1331
Fax Number	:

Provider Business Practice Location Address
First Line	:	28 N BARBARA ST
Second Line	:
City	:	MOUNT JOY
State	:	PA
Zip	:	17552-1402
Country	:	US
Telephone Number	:	215-480-1331
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ELI KATZ
Credential	:	DMD
Telephone Number	:	215-480-1331

Provider Enumeration Date	:	03/26/2018
Last Update Date	:	03/26/2018

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