Provider Demographics
NPI:1013962323
Name:BIOESTHETIC DENTISTRY, INC
Entity Type:Organization
Organization Name:BIOESTHETIC DENTISTRY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:V
Authorized Official - Last Name:BROGNA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD,FAGD
Authorized Official - Phone:610-688-4100
Mailing Address - Street 1:227 W LANCASTER AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DEVON
Mailing Address - State:PA
Mailing Address - Zip Code:19333-1555
Mailing Address - Country:US
Mailing Address - Phone:610-688-4100
Mailing Address - Fax:610-995-0501
Practice Address - Street 1:227 W LANCASTER AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:DEVON
Practice Address - State:PA
Practice Address - Zip Code:19333-1555
Practice Address - Country:US
Practice Address - Phone:610-688-4100
Practice Address - Fax:610-995-0501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADSO27317L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty