Provider Demographics
NPI:1801162219
Name:SPECIAL CARE DENTAL OF PENNSYLVANIA-CKK LLC
Entity type:Organization
Organization Name:SPECIAL CARE DENTAL OF PENNSYLVANIA-CKK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:KROWICKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:855-259-9183
Mailing Address - Street 1:639 RED LION RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-6216
Mailing Address - Country:US
Mailing Address - Phone:855-259-9183
Mailing Address - Fax:800-485-1881
Practice Address - Street 1:639 RED LION RD
Practice Address - Street 2:
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-6216
Practice Address - Country:US
Practice Address - Phone:855-259-9183
Practice Address - Fax:800-485-1881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS036946122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty