Provider Demographics
NPI:1457454613
Name:LEDINGHAM DENTAL CORP., PA
Entity Type:Organization
Organization Name:LEDINGHAM DENTAL CORP., PA
Other - Org Name:DENTAL VILLAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:GLEN
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-319-1390
Mailing Address - Street 1:5213 N ORACLE RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-3707
Mailing Address - Country:US
Mailing Address - Phone:520-319-1390
Mailing Address - Fax:520-881-5133
Practice Address - Street 1:5209 N ORACLE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-3707
Practice Address - Country:US
Practice Address - Phone:520-293-9277
Practice Address - Fax:520-881-5133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty