Provider Demographics
NPI:1578016689
Name:PEDIATRIC DENTISTRY OF READING P.C.
Entity Type:Organization
Organization Name:PEDIATRIC DENTISTRY OF READING P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BETHANY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRATSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:724-601-6951
Mailing Address - Street 1:5001 PERKIOMEN AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19606-9614
Mailing Address - Country:US
Mailing Address - Phone:484-334-2310
Mailing Address - Fax:484-334-2311
Practice Address - Street 1:5001 PERKIOMEN AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19606-9614
Practice Address - Country:US
Practice Address - Phone:484-334-2310
Practice Address - Fax:484-334-2311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS038715261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental