MEDICARE: THORNDALE PEDIATRIC DENTISTRY

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	1223P0221X	Pediatric Dentistry	DS030525-L	PA

General Provider Information

NPI Number	:	1942223383
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THORNDALE PEDIATRIC DENTISTRY

Provider Business Mailing Address
First Line	:	3915 W LINCOLN HWY
Second Line	:
City	:	DOWNINGTOWN
State	:	PA
Zip	:	19335-5502
Country	:	US
Telephone Number	:	610-269-1900
Fax Number	:	610-269-2725

Provider Business Practice Location Address
First Line	:	3915 W LINCOLN HWY
Second Line	:
City	:	DOWNINGTOWN
State	:	PA
Zip	:	19335-5502
Country	:	US
Telephone Number	:	610-269-1900
Fax Number	:	610-269-2725

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ERIC FELIX
Credential	:	DMD
Telephone Number	:	610-269-1900

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	08/22/2020

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