Provider Demographics
NPI:1457865511
Name:DR.SUBHA FAMILY DENTISTRY
Entity Type:Organization
Organization Name:DR.SUBHA FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:SUBHASHINI
Authorized Official - Middle Name:
Authorized Official - Last Name:PAMULAPATI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:610-530-1777
Mailing Address - Street 1:5940 HAMILTON BLVD
Mailing Address - Street 2:
Mailing Address - City:WESCOSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18106-9648
Mailing Address - Country:US
Mailing Address - Phone:610-530-1777
Mailing Address - Fax:610-530-8777
Practice Address - Street 1:5940 HAMILTON BLVD
Practice Address - Street 2:
Practice Address - City:WESCOSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18106-9648
Practice Address - Country:US
Practice Address - Phone:610-530-1777
Practice Address - Fax:610-530-8777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-28
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0380521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102405691Medicaid