Provider Demographics
NPI:1053662957
Name:LOWER MERION PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:LOWER MERION PEDIATRIC DENTISTRY
Other - Org Name:LOWER MERION PEDIATRIC AND ADOLESCENT DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:HANS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:610-642-3417
Mailing Address - Street 1:42 W LANCASTER AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ARDMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19003-1331
Mailing Address - Country:US
Mailing Address - Phone:610-642-3417
Mailing Address - Fax:610-642-2447
Practice Address - Street 1:42 W LANCASTER AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:ARDMORE
Practice Address - State:PA
Practice Address - Zip Code:19003-1331
Practice Address - Country:US
Practice Address - Phone:610-642-3417
Practice Address - Fax:610-642-2447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-02
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-029284L1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty