Provider Demographics
NPI:1184129603
Name:AMDENT LTD
Entity type:Organization
Organization Name:AMDENT LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:L
Authorized Official - Last Name:FITZCHARLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-372-6313
Mailing Address - Street 1:1301 PENN AVE
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-2140
Mailing Address - Country:US
Mailing Address - Phone:610-372-6313
Mailing Address - Fax:267-991-8174
Practice Address - Street 1:545 W MAIN ST STE 11
Practice Address - Street 2:
Practice Address - City:TRAPPE
Practice Address - State:PA
Practice Address - Zip Code:19426-1981
Practice Address - Country:US
Practice Address - Phone:484-200-7355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMDENT LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-27
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty