Provider Demographics
NPI:1952493009
Name:MAIN LINE DENTAL HEALTH ASSOCIATES
Entity Type:Organization
Organization Name:MAIN LINE DENTAL HEALTH ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JEFFERY
Authorized Official - Last Name:SNIDER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:610-642-6965
Mailing Address - Street 1:100 EAST LANCASTER AVENUE
Mailing Address - Street 2:664 LANKENAU MEDICAL BUILDING EAST
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3450
Mailing Address - Country:US
Mailing Address - Phone:610-642-6965
Mailing Address - Fax:610-642-0286
Practice Address - Street 1:100 EAST LANCASTER AVENUE
Practice Address - Street 2:664 LANKENAU MEDICAL BUILDING EAST
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3450
Practice Address - Country:US
Practice Address - Phone:610-642-6965
Practice Address - Fax:610-642-0286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS02292511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA887426OtherUNITED CONCORDIA