Provider Demographics
NPI:1538503115
Name:JUSTA FARM DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:JUSTA FARM DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:FISHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, FAGD
Authorized Official - Phone:215-322-8711
Mailing Address - Street 1:1946 COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-1738
Mailing Address - Country:US
Mailing Address - Phone:215-322-8711
Mailing Address - Fax:215-322-8789
Practice Address - Street 1:1946 COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-1738
Practice Address - Country:US
Practice Address - Phone:215-322-8711
Practice Address - Fax:215-322-8789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-25
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty