Provider Demographics
NPI:1225453442
Name:ANTHONY FAROLE DMD, INC.
Entity Type:Organization
Organization Name:ANTHONY FAROLE DMD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:FAROLE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:610-668-3300
Mailing Address - Street 1:380 SHELBOURNE LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-5743
Mailing Address - Country:US
Mailing Address - Phone:610-668-3300
Mailing Address - Fax:610-668-4038
Practice Address - Street 1:191 PRESIDENTIAL BLVD
Practice Address - Street 2:W2
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1207
Practice Address - Country:US
Practice Address - Phone:610-668-3300
Practice Address - Fax:610-668-4038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-25
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS022779L261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA084340Medicare UPIN