Provider Demographics
NPI:1710236526
Name:WILLIAM PENN DENTAL CENTER
Entity Type:Organization
Organization Name:WILLIAM PENN DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:GHADAMI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:610-258-2000
Mailing Address - Street 1:701 VILLAGE AT STONES CROSSING RD
Mailing Address - Street 2:701 VILLAGE AT STONES CROSSING ROAD
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045-5081
Mailing Address - Country:US
Mailing Address - Phone:610-258-2000
Mailing Address - Fax:610-258-2400
Practice Address - Street 1:701 VILLAGE AT STONES CROSSING RD
Practice Address - Street 2:701 VILLAGE AT STONES CROSSING ROAD
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-5081
Practice Address - Country:US
Practice Address - Phone:610-258-2000
Practice Address - Fax:610-258-2400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-07
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS038126122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty