Provider Demographics
NPI:1285634816
Name:PROSTHODONTICS INTERMEDICA
Entity Type:Organization
Organization Name:PROSTHODONTICS INTERMEDICA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:BALSHI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:215-646-6334
Mailing Address - Street 1:467 PENNSYLVANIA AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-3420
Mailing Address - Country:US
Mailing Address - Phone:215-646-6334
Mailing Address - Fax:215-643-1149
Practice Address - Street 1:467 PENNSYLVANIA AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:FORT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034-3420
Practice Address - Country:US
Practice Address - Phone:215-646-6334
Practice Address - Fax:215-643-1149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS017634L1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT28626Medicare UPIN