Provider Demographics
NPI:1982825386
Name:KUTZTOWN DENTAL CENTER P.C.
Entity Type:Organization
Organization Name:KUTZTOWN DENTAL CENTER P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:EPES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:610-683-7112
Mailing Address - Street 1:404 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KUTZTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19530-1608
Mailing Address - Country:US
Mailing Address - Phone:610-683-7112
Mailing Address - Fax:610-683-7376
Practice Address - Street 1:404 W MAIN ST
Practice Address - Street 2:
Practice Address - City:KUTZTOWN
Practice Address - State:PA
Practice Address - Zip Code:19530-1608
Practice Address - Country:US
Practice Address - Phone:610-683-7112
Practice Address - Fax:610-683-7376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS020557L1223G0001X
PADS024208L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1154389377OtherGENERAL DENTIST
PA1245332907OtherGENERAL DENTIST