Provider Demographics
NPI:1366496408
Name:W. R. UEBERROTH, DDS, PC
Entity Type:Organization
Organization Name:W. R. UEBERROTH, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ PRIMARY GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KONSTANTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KRITIKOS-KARALIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:610-582-1594
Mailing Address - Street 1:117 N FURNACE ST
Mailing Address - Street 2:
Mailing Address - City:BIRDSBORO
Mailing Address - State:PA
Mailing Address - Zip Code:19508-2022
Mailing Address - Country:US
Mailing Address - Phone:610-582-1594
Mailing Address - Fax:610-404-7818
Practice Address - Street 1:117 N FURNACE ST
Practice Address - Street 2:
Practice Address - City:BIRDSBORO
Practice Address - State:PA
Practice Address - Zip Code:19508-2022
Practice Address - Country:US
Practice Address - Phone:610-582-1594
Practice Address - Fax:610-404-7818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029973L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty