Provider Demographics
NPI:1629117098
Name:PARKLAND DENTAL CENTER PC
Entity Type:Organization
Organization Name:PARKLAND DENTAL CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:W
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:610-434-3390
Mailing Address - Street 1:1605 N CEDAR CREST BLVD
Mailing Address - Street 2:SUITE 409
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104
Mailing Address - Country:US
Mailing Address - Phone:610-434-3390
Mailing Address - Fax:610-434-3635
Practice Address - Street 1:1605 N CEDAR CREST BLVD
Practice Address - Street 2:SUITE 409
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104
Practice Address - Country:US
Practice Address - Phone:610-434-3390
Practice Address - Fax:610-434-3635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS021724L1223G0001X
PADS026311L1223G0001X
PADS026533L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty