Provider Demographics
NPI:1952631749
Name:LANGHORNE DENTAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:LANGHORNE DENTAL ASSOCIATES LLC
Other - Org Name:SIMPLY BEAUTIFUL SMILES OF LANGHORNE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:GERARDO
Authorized Official - Middle Name:IVAN
Authorized Official - Last Name:PORTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-650-4955
Mailing Address - Street 1:330 MIDDLETOWN BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047
Mailing Address - Country:US
Mailing Address - Phone:215-757-1574
Mailing Address - Fax:215-757-4909
Practice Address - Street 1:330 MIDDLETOWN BOULEVARD
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047
Practice Address - Country:US
Practice Address - Phone:215-757-1574
Practice Address - Fax:215-757-4909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-30
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty