Provider Demographics
NPI:1356768832
Name:D.R. DENTAL LLC
Entity type:Organization
Organization Name:D.R. DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:RECIGNO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:267-481-1717
Mailing Address - Street 1:PO BOX 1303
Mailing Address - Street 2:
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-5403
Mailing Address - Country:US
Mailing Address - Phone:267-481-1717
Mailing Address - Fax:
Practice Address - Street 1:519 DAVISVILLE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-1525
Practice Address - Country:US
Practice Address - Phone:215-659-1245
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-24
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS037860122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty