Provider Demographics
NPI:1255506887
Name:PLYMOUTH PERIODONTICS
Entity Type:Organization
Organization Name:PLYMOUTH PERIODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/PERIODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:HALPERN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:610-825-4334
Mailing Address - Street 1:120 W GERMANTOWN PIKE
Mailing Address - Street 2:SUITE 225
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-1420
Mailing Address - Country:US
Mailing Address - Phone:610-825-4334
Mailing Address - Fax:610-825-4747
Practice Address - Street 1:120 W GERMANTOWN PIKE
Practice Address - Street 2:SUITE 225
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1420
Practice Address - Country:US
Practice Address - Phone:610-825-4334
Practice Address - Fax:610-825-4747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0353061223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty