Provider Demographics
NPI:1750618252
Name:PEDIATRIC DENTISTRY AT LONGWOOD
Entity type:Organization
Organization Name:PEDIATRIC DENTISTRY AT LONGWOOD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:MELINI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:1610-316-8400
Mailing Address - Street 1:400 MCFARLAN RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348-2477
Mailing Address - Country:US
Mailing Address - Phone:610-925-5700
Mailing Address - Fax:
Practice Address - Street 1:400 MCFARLAN RD
Practice Address - Street 2:SUITE 200
Practice Address - City:KENNETT SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19348-2477
Practice Address - Country:US
Practice Address - Phone:610-925-5700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-04
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty