Provider Demographics
NPI:1760827927
Name:ADVANCED DENTISTRY
Entity Type:Organization
Organization Name:ADVANCED DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:KRIEBEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-770-1966
Mailing Address - Street 1:721 BETHLEHEM PIKE
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18936-9602
Mailing Address - Country:US
Mailing Address - Phone:267-649-7523
Mailing Address - Fax:267-263-2184
Practice Address - Street 1:721 BETHLEHEM PIKE
Practice Address - Street 2:
Practice Address - City:MONTGOMERYVILLE
Practice Address - State:PA
Practice Address - Zip Code:18936-9602
Practice Address - Country:US
Practice Address - Phone:267-649-7523
Practice Address - Fax:267-263-2184
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED DENTISTRY OF CITY AVE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-05-01
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization