Provider Demographics
NPI:1417264367
Name:BACHSTEIN DENTAL ESTHETICS, LLC
Entity Type:Organization
Organization Name:BACHSTEIN DENTAL ESTHETICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:KARL
Authorized Official - Last Name:BACHSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:610-353-0753
Mailing Address - Street 1:3475 W CHESTER PIKE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-4294
Mailing Address - Country:US
Mailing Address - Phone:610-353-0753
Mailing Address - Fax:610-353-5396
Practice Address - Street 1:3475 W CHESTER PIKE
Practice Address - Street 2:SUITE 230
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-4294
Practice Address - Country:US
Practice Address - Phone:610-353-0753
Practice Address - Fax:610-353-5396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030932L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty