Provider Demographics
NPI:1619091196
Name:KWH DENTAL ASSOC. P.C.
Entity Type:Organization
Organization Name:KWH DENTAL ASSOC. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:KANNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:215-757-1574
Mailing Address - Street 1:680 MIDDLETOWN BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1817
Mailing Address - Country:US
Mailing Address - Phone:215-757-1574
Mailing Address - Fax:215-757-4909
Practice Address - Street 1:680 MIDDLETOWN BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1817
Practice Address - Country:US
Practice Address - Phone:215-757-1574
Practice Address - Fax:215-757-4909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS017625L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty