Provider Demographics
NPI:1942223383
Name:THORNDALE PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:THORNDALE PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:FELIX
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:610-269-1900
Mailing Address - Street 1:3915 W LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-5502
Mailing Address - Country:US
Mailing Address - Phone:610-269-1900
Mailing Address - Fax:610-269-2725
Practice Address - Street 1:3915 W LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:DOWNINGTOWN
Practice Address - State:PA
Practice Address - Zip Code:19335-5502
Practice Address - Country:US
Practice Address - Phone:610-269-1900
Practice Address - Fax:610-269-2725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030525-L1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty