MEDICARE: MERION FAMILY 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	261QD0000X	Dental Clinic/Center	DS039334	PA

General Provider Information

NPI Number	:	1982101325
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERION FAMILY DENTISTRY

Provider Business Mailing Address
First Line	:	352 MONTGOMERY AVE
Second Line	:
City	:	MERION STATION
State	:	PA
Zip	:	19066-1202
Country	:	US
Telephone Number	:	484-278-4441
Fax Number	:

Provider Business Practice Location Address
First Line	:	352 MONTGOMERY AVE
Second Line	:
City	:	MERION STATION
State	:	PA
Zip	:	19066-1202
Country	:	US
Telephone Number	:	484-278-4441
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	DR. DANA KUPFER
Credential	:
Telephone Number	:	973-493-3814

Provider Enumeration Date	:	04/11/2018
Last Update Date	:	04/11/2018

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Directions to “MERION FAMILY DENTISTRY ” Practice Location

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