Provider Demographics
NPI:1649438839
Name:LIONVILLE DENTAL ASSOCIATES, LLC
Entity type:Organization
Organization Name:LIONVILLE DENTAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:ZACCARIA
Authorized Official - Suffix:
Authorized Official - Credentials:DDR
Authorized Official - Phone:610-594-2001
Mailing Address - Street 1:67 DOWLIN FORGE RD STE C
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-1548
Mailing Address - Country:US
Mailing Address - Phone:610-594-2001
Mailing Address - Fax:
Practice Address - Street 1:67 DOWLIN FORGE RD STE C
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-1548
Practice Address - Country:US
Practice Address - Phone:610-594-2001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-26
Last Update Date:2008-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS017468L261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental