Provider Demographics
NPI:1770969552
Name:NARBERTH DENTAL GROUP, LLC.
Entity type:Organization
Organization Name:NARBERTH DENTAL GROUP, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHARINE
Authorized Official - Middle Name:EMILIE
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:610-667-6630
Mailing Address - Street 1:145 N. NARBERTH AVE.
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:NARBERTH
Mailing Address - State:PA
Mailing Address - Zip Code:19072
Mailing Address - Country:US
Mailing Address - Phone:610-667-6630
Mailing Address - Fax:610-667-6631
Practice Address - Street 1:145 N. NARBERTH AVE.
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NARBERTH
Practice Address - State:PA
Practice Address - Zip Code:19072
Practice Address - Country:US
Practice Address - Phone:610-667-6630
Practice Address - Fax:610-667-6631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0360611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty