Provider Demographics
NPI:1356805337
Name:WOODLYN DENTISTRY GROUP LLC
Entity type:Organization
Organization Name:WOODLYN DENTISTRY GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:WINFREE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-833-2660
Mailing Address - Street 1:550 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:WOODLYN
Mailing Address - State:PA
Mailing Address - Zip Code:19094-1014
Mailing Address - Country:US
Mailing Address - Phone:610-833-2660
Mailing Address - Fax:610-833-5833
Practice Address - Street 1:550 FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:WOODLYN
Practice Address - State:PA
Practice Address - Zip Code:19094-1014
Practice Address - Country:US
Practice Address - Phone:610-833-2660
Practice Address - Fax:610-833-5833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty