Provider Demographics
NPI:1770861130
Name:DENTEX DENTAL GROUP
Entity Type:Organization
Organization Name:DENTEX DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:EICHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:215-462-4047
Mailing Address - Street 1:1701 E MOYAMENSING AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19148-1931
Mailing Address - Country:US
Mailing Address - Phone:215-462-4034
Mailing Address - Fax:
Practice Address - Street 1:1701 E MOYAMENSING AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148-1931
Practice Address - Country:US
Practice Address - Phone:215-462-4034
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-02
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty