Provider Demographics
NPI:1851424972
Name:JENNERSVILLE FAMILY DENTISTRY
Entity Type:Organization
Organization Name:JENNERSVILLE FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:F
Authorized Official - Last Name:MILANO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:610-345-0700
Mailing Address - Street 1:900 W. BALTIMORE PIKE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WEST GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19390-9178
Mailing Address - Country:US
Mailing Address - Phone:610-345-0700
Mailing Address - Fax:610-345-0660
Practice Address - Street 1:900 W. BALTIMORE PIKE
Practice Address - Street 2:SUITE 100
Practice Address - City:WEST GROVE
Practice Address - State:PA
Practice Address - Zip Code:19390-9178
Practice Address - Country:US
Practice Address - Phone:610-345-0700
Practice Address - Fax:610-345-0660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0353851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty