Provider Demographics
NPI:1255065942
Name:BOYERTOWN FAMILY DENTISTRY PC
Entity type:Organization
Organization Name:BOYERTOWN FAMILY DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NIL
Authorized Official - Middle Name:
Authorized Official - Last Name:DHANANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-886-7974
Mailing Address - Street 1:24 E PHILADELPHIA AVE
Mailing Address - Street 2:
Mailing Address - City:BOYERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19512-1125
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:24 E PHILADELPHIA AVE
Practice Address - Street 2:
Practice Address - City:BOYERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19512-1125
Practice Address - Country:US
Practice Address - Phone:610-367-1511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental