Provider Demographics
NPI:1811449374
Name:POTTSTOWN PEDIATRIC DENTISTRY & ORTHODONTICS PC
Entity type:Organization
Organization Name:POTTSTOWN PEDIATRIC DENTISTRY & ORTHODONTICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDSLEGER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:610-337-2325
Mailing Address - Street 1:596 LANCASTER AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-1808
Mailing Address - Country:US
Mailing Address - Phone:484-679-4071
Mailing Address - Fax:610-884-9296
Practice Address - Street 1:625 N. POTTSTOWN PIKE
Practice Address - Street 2:SUITE 2-N
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464
Practice Address - Country:US
Practice Address - Phone:610-337-2325
Practice Address - Fax:610-337-3863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-01
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1223X0400X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty