Provider Demographics
NPI:1811216104
Name:BEAR CREEK DENTAL, PC
Entity Type:Organization
Organization Name:BEAR CREEK DENTAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENDAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BLYMIRE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:610-967-1500
Mailing Address - Street 1:109 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ALBURTIS
Mailing Address - State:PA
Mailing Address - Zip Code:18011-9572
Mailing Address - Country:US
Mailing Address - Phone:610-967-1500
Mailing Address - Fax:610-967-3100
Practice Address - Street 1:109 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ALBURTIS
Practice Address - State:PA
Practice Address - Zip Code:18011-9572
Practice Address - Country:US
Practice Address - Phone:610-967-1500
Practice Address - Fax:610-967-3100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-26
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADSO366831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty