Provider Demographics
NPI:1801947775
Name:PENN'S COMMONS DENTAL GROUP
Entity type:Organization
Organization Name:PENN'S COMMONS DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:D
Authorized Official - Last Name:EARNSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-374-8009
Mailing Address - Street 1:560 VAN REED RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-1799
Mailing Address - Country:US
Mailing Address - Phone:610-374-8009
Mailing Address - Fax:610-374-5552
Practice Address - Street 1:560 VAN REED RD
Practice Address - Street 2:SUITE 202
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1799
Practice Address - Country:US
Practice Address - Phone:610-374-8009
Practice Address - Fax:610-374-5552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty