Provider Demographics
NPI:1780780387
Name:EDELSON-SLOCUM, LINDA BARBARA (DMD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:BARBARA
Last Name:EDELSON-SLOCUM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 CHERRY BLOSSOM DR
Mailing Address - Street 2:
Mailing Address - City:CHURCHVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18966-1061
Mailing Address - Country:US
Mailing Address - Phone:215-322-5361
Mailing Address - Fax:215-322-3923
Practice Address - Street 1:5 CHERRY BLOSSOM DR
Practice Address - Street 2:
Practice Address - City:CHURCHVILLE
Practice Address - State:PA
Practice Address - Zip Code:18966-1061
Practice Address - Country:US
Practice Address - Phone:215-322-5361
Practice Address - Fax:215-322-3923
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS024052L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice