Provider Demographics
NPI:1912001298
Name:DOYLESTOWN DENTAL ASSOCIATES PC
Entity Type:Organization
Organization Name:DOYLESTOWN DENTAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:TRACHTENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:215-348-4172
Mailing Address - Street 1:708 SHADY RETREAT RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18901
Mailing Address - Country:US
Mailing Address - Phone:215-348-4172
Mailing Address - Fax:215-348-9342
Practice Address - Street 1:708 SHADY RETREAT RD
Practice Address - Street 2:SUITE 6
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901
Practice Address - Country:US
Practice Address - Phone:215-348-4172
Practice Address - Fax:215-348-9342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS021017L122300000X
PADS029525L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty