Provider Demographics
NPI:1063634244
Name:BRYN MAWR PERIODONTAL ASSOCIATES, LTD.
Entity Type:Organization
Organization Name:BRYN MAWR PERIODONTAL ASSOCIATES, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:WOEHLING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:610-525-8485
Mailing Address - Street 1:1201 COUNTY LINE RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-2636
Mailing Address - Country:US
Mailing Address - Phone:610-525-8485
Mailing Address - Fax:
Practice Address - Street 1:1201 COUNTY LINE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-2636
Practice Address - Country:US
Practice Address - Phone:610-525-8485
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS019952-L1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty