Provider Demographics
NPI:1033190640
Name:BEDFORD DENTAL PROFESSIONAL CORP
Entity Type:Organization
Organization Name:BEDFORD DENTAL PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CORP
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:STIFFLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:814-623-2217
Mailing Address - Street 1:902 ECHO VALE DR
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15522
Mailing Address - Country:US
Mailing Address - Phone:814-623-2217
Mailing Address - Fax:814-623-6271
Practice Address - Street 1:902 ECHO VALE DR
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:PA
Practice Address - Zip Code:15522
Practice Address - Country:US
Practice Address - Phone:814-623-2217
Practice Address - Fax:814-623-6271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS020764L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty