Provider Demographics
NPI:1336673417
Name:BALA KIDS DENTISTRY
Entity Type:Organization
Organization Name:BALA KIDS DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:WAXMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-667-6161
Mailing Address - Street 1:15 N PRESIDENTIAL BLVD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1006
Mailing Address - Country:US
Mailing Address - Phone:610-336-8478
Mailing Address - Fax:610-617-9275
Practice Address - Street 1:15 N PRESIDENTIAL BLVD
Practice Address - Street 2:SUITE 303
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1006
Practice Address - Country:US
Practice Address - Phone:610-336-8478
Practice Address - Fax:610-617-9275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-17
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0408521223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty