Provider Demographics
NPI:1942418363
Name:WILLIAMSBURG DENTAL, P.C.
Entity Type:Organization
Organization Name:WILLIAMSBURG DENTAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:A
Authorized Official - Last Name:FERRETTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-353-2700
Mailing Address - Street 1:601 WILLIAMSBURG DR
Mailing Address - Street 2:
Mailing Address - City:BROOMALL
Mailing Address - State:PA
Mailing Address - Zip Code:19008-3428
Mailing Address - Country:US
Mailing Address - Phone:610-353-2700
Mailing Address - Fax:610-353-5528
Practice Address - Street 1:601 WILLIAMSBURG DR
Practice Address - Street 2:
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-3428
Practice Address - Country:US
Practice Address - Phone:610-353-2700
Practice Address - Fax:610-353-5528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA051555OtherUNITED CONCORDIA NON PART
PA124133OtherUNITED CONCORDIA PART