Provider Demographics
NPI:1225404577
Name:FAIRVIEW DENTAL ARTS PC
Entity Type:Organization
Organization Name:FAIRVIEW DENTAL ARTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:ANDOLINO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:610-630-2373
Mailing Address - Street 1:1009 VALLEY FORGE RD
Mailing Address - Street 2:
Mailing Address - City:EAGLEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19403-1022
Mailing Address - Country:US
Mailing Address - Phone:610-630-2373
Mailing Address - Fax:
Practice Address - Street 1:1009 VALLEY FORGE RD
Practice Address - Street 2:
Practice Address - City:EAGLEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19403-1022
Practice Address - Country:US
Practice Address - Phone:610-630-2373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-20
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS035996122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty