Provider Demographics
NPI:1235593443
Name:CCD DENTAL INNOVATIONS, LLC
Entity Type:Organization
Organization Name:CCD DENTAL INNOVATIONS, LLC
Other - Org Name:DENTAL INNOVATIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-646-3040
Mailing Address - Street 1:601D BETHLEHEM PIKE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MONTGOMERYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18936-9713
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:601D BETHLEHEM PIKE
Practice Address - Street 2:SUITE 200
Practice Address - City:MONTGOMERYVILLE
Practice Address - State:PA
Practice Address - Zip Code:18936-9713
Practice Address - Country:US
Practice Address - Phone:215-646-3040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-13
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty