Provider Demographics
NPI:1669918090
Name:QUALDENT
Entity type:Organization
Organization Name:QUALDENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-760-6256
Mailing Address - Street 1:2600 PHILMONT AVE
Mailing Address - Street 2:SUITE 212-A
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-5306
Mailing Address - Country:US
Mailing Address - Phone:610-619-0061
Mailing Address - Fax:
Practice Address - Street 1:2600 PHILMONT AVE
Practice Address - Street 2:SUITE 212-A
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-5306
Practice Address - Country:US
Practice Address - Phone:610-619-0061
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-09
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1275727430122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty