Provider Demographics
NPI:1407998396
Name:STRAFFORD DENTAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:STRAFFORD DENTAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:S
Authorized Official - Last Name:GARTNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:610-688-2230
Mailing Address - Street 1:512 W LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:STRAFFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19087-3122
Mailing Address - Country:US
Mailing Address - Phone:610-688-2230
Mailing Address - Fax:610-688-2230
Practice Address - Street 1:512 W LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:STRAFFORD
Practice Address - State:PA
Practice Address - Zip Code:19087-3122
Practice Address - Country:US
Practice Address - Phone:610-688-2230
Practice Address - Fax:610-688-2230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-022239-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty