Provider Demographics
NPI:1942665377
Name:COMPLETE DENTAL SOLUTION OF LIMERICK LLC
Entity Type:Organization
Organization Name:COMPLETE DENTAL SOLUTION OF LIMERICK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:610-308-6609
Mailing Address - Street 1:292 W.RIDGE PIKE
Mailing Address - Street 2:BUILDING B, 2ND FL
Mailing Address - City:LIMERICK
Mailing Address - State:PA
Mailing Address - Zip Code:19468
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:292 W RIDGE PIKE
Practice Address - Street 2:BUILDING B, 2ND FL
Practice Address - City:LIMERICK
Practice Address - State:PA
Practice Address - Zip Code:19468-3716
Practice Address - Country:US
Practice Address - Phone:610-308-6609
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-30
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS027446-L261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental