Provider Demographics
NPI:1235566175
Name:HARELYSVILLE FAMILY DENTISTRY LLC
Entity Type:Organization
Organization Name:HARELYSVILLE FAMILY DENTISTRY LLC
Other - Org Name:TOWAMENCIN DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROFESSIONAL DEVELOPMENT EXEC.
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-550-7185
Mailing Address - Street 1:401 COMMERCE DR
Mailing Address - Street 2:SUITE 401
Mailing Address - City:FT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-2714
Mailing Address - Country:US
Mailing Address - Phone:215-550-7186
Mailing Address - Fax:215-646-6166
Practice Address - Street 1:456 SCHOOL LN
Practice Address - Street 2:SUITE 105
Practice Address - City:HARLEYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19438-1703
Practice Address - Country:US
Practice Address - Phone:215-867-4561
Practice Address - Fax:215-646-6166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-10
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS037756122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty