Provider Demographics
NPI:1285085282
Name:BUCKSTOWN DENTAL ASSICIATES, LLC
Entity type:Organization
Organization Name:BUCKSTOWN DENTAL ASSICIATES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:D'ANGELO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:215-816-5408
Mailing Address - Street 1:400 N BUCKSTOWN RD
Mailing Address - Street 2:SUITE 1-C
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-8310
Mailing Address - Country:US
Mailing Address - Phone:215-750-1717
Mailing Address - Fax:215-750-6190
Practice Address - Street 1:400 N BUCKSTOWN RD
Practice Address - Street 2:SUITE 1-C
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-8310
Practice Address - Country:US
Practice Address - Phone:215-750-1717
Practice Address - Fax:215-750-6190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-30
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS027954L1223P0221X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty