Provider Demographics
NPI:1679023741
Name:BEDFORD DENTAL HEALTH CENTER LLC
Entity Type:Organization
Organization Name:BEDFORD DENTAL HEALTH CENTER LLC
Other - Org Name:BEDFORD DENTAL HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMAINE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:240-580-0277
Mailing Address - Street 1:403 S JULIANA ST
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15522-1825
Mailing Address - Country:US
Mailing Address - Phone:814-623-8747
Mailing Address - Fax:
Practice Address - Street 1:403 S JULIANA ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:PA
Practice Address - Zip Code:15522-1825
Practice Address - Country:US
Practice Address - Phone:814-623-8747
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0410661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty