Provider Demographics
NPI:1649574906
Name:CENTRE FOR COSMETIC DENTISTRY
Entity Type:Organization
Organization Name:CENTRE FOR COSMETIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:H
Authorized Official - Last Name:BARBOZA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:610-459-5002
Mailing Address - Street 1:275 WILMINGTON W CHESTER PIKE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:CHADDS FORD
Mailing Address - State:PA
Mailing Address - Zip Code:19317-9077
Mailing Address - Country:US
Mailing Address - Phone:610-459-5002
Mailing Address - Fax:610-459-5468
Practice Address - Street 1:275 WILMINGTON W CHESTER PIKE
Practice Address - Street 2:SUITE 111
Practice Address - City:CHADDS FORD
Practice Address - State:PA
Practice Address - Zip Code:19317-9077
Practice Address - Country:US
Practice Address - Phone:610-459-5002
Practice Address - Fax:610-459-5468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-30
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS025344L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty