Provider Demographics
NPI:1649676206
Name:DENTAL HEALTH AND HEALING
Entity type:Organization
Organization Name:DENTAL HEALTH AND HEALING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:GALE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MOSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-647-2755
Mailing Address - Street 1:307 HILLENDALE RD
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19311-9742
Mailing Address - Country:US
Mailing Address - Phone:610-647-2755
Mailing Address - Fax:610-444-5607
Practice Address - Street 1:307 HILLENDALE RD
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:PA
Practice Address - Zip Code:19311-9742
Practice Address - Country:US
Practice Address - Phone:610-647-2755
Practice Address - Fax:610-444-5607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-10
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS018325L261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADS018325LOtherSTATE DENTAL LICENSE NUMBER