Provider Demographics
NPI:1114904331
Name:EHRENS, J VICTOR (DMD)
Entity Type:Individual
Prefix:DR
First Name:J
Middle Name:VICTOR
Last Name:EHRENS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1251 S CEDAR CREST BLVD
Mailing Address - Street 2:SUITE 311
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6205
Mailing Address - Country:US
Mailing Address - Phone:610-435-6161
Mailing Address - Fax:610-435-2902
Practice Address - Street 1:1251 S CEDAR CREST BLVD
Practice Address - Street 2:SUITE 311
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6205
Practice Address - Country:US
Practice Address - Phone:610-435-6161
Practice Address - Fax:610-435-2902
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS019847L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA157951OtherHIGHMARK BS #
PA0003889OtherAETNA
PA50047080OtherCAPITAL BLUE CROSS #
PA157951OtherHIGHMARK BS #