Provider Demographics
NPI:1982864492
Name:GUNAWARDENA, DILSHAN N (MD, DMD, FACS)
Entity Type:Individual
Prefix:DR
First Name:DILSHAN
Middle Name:N
Last Name:GUNAWARDENA
Suffix:
Gender:M
Credentials:MD, DMD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 YORK RD
Mailing Address - Street 2:
Mailing Address - City:WARMINSTER
Mailing Address - State:PA
Mailing Address - Zip Code:18974-4521
Mailing Address - Country:US
Mailing Address - Phone:215-672-6560
Mailing Address - Fax:215-672-7343
Practice Address - Street 1:158 YORK RD
Practice Address - Street 2:
Practice Address - City:WARMINSTER
Practice Address - State:PA
Practice Address - Zip Code:18974-4521
Practice Address - Country:US
Practice Address - Phone:215-672-6560
Practice Address - Fax:215-672-7343
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT101371223G0001X
PADS0398541223S0112X
PAMD452026204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223G0001XDental ProvidersDentistGeneral Practice
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT10137OtherSTATE LICENSE