Provider Demographics
NPI:1457470395
Name:DANCU, JOHN KENNETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:KENNETH
Last Name:DANCU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 LAKESIDE PARK
Mailing Address - Street 2:LAKESIDE OFFICE PARK
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-4049
Mailing Address - Country:US
Mailing Address - Phone:215-355-0112
Mailing Address - Fax:215-355-8930
Practice Address - Street 1:204 LAKESIDE PARK
Practice Address - Street 2:LAKESIDE OFFICE PARK
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-4049
Practice Address - Country:US
Practice Address - Phone:215-355-0112
Practice Address - Fax:215-355-8930
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS020666L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice