Provider Demographics
NPI:1962676023
Name:LANSDALE DENTAL PC
Entity Type:Organization
Organization Name:LANSDALE DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT LANSDALE DENTAL PC
Authorized Official - Prefix:
Authorized Official - First Name:GOPIMANOHAR
Authorized Official - Middle Name:NANGIR
Authorized Official - Last Name:VARMA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:215-393-9008
Mailing Address - Street 1:233 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446
Mailing Address - Country:US
Mailing Address - Phone:215-393-9008
Mailing Address - Fax:215-393-9015
Practice Address - Street 1:233 S BROAD ST
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446
Practice Address - Country:US
Practice Address - Phone:215-393-9008
Practice Address - Fax:215-393-9015
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LANSDALE DENTAL PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty