Provider Demographics
NPI:1396851937
Name:COLLEGEVILLE DENTAL ASSOCIATES PC
Entity Type:Organization
Organization Name:COLLEGEVILLE DENTAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:ESTELLE
Authorized Official - Suffix:IX
Authorized Official - Credentials:DMD
Authorized Official - Phone:610-489-4331
Mailing Address - Street 1:468 E MAIN ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19426
Mailing Address - Country:US
Mailing Address - Phone:610-489-4331
Mailing Address - Fax:610-454-9861
Practice Address - Street 1:468 E MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426
Practice Address - Country:US
Practice Address - Phone:610-489-4331
Practice Address - Fax:610-454-9861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030535L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty