Provider Demographics
NPI:1811643703
Name:SEPA DENTAL LLC
Entity type:Organization
Organization Name:SEPA DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RIINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELSEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:609-792-3237
Mailing Address - Street 1:1476 MUNDOCK RD
Mailing Address - Street 2:
Mailing Address - City:DRESHER
Mailing Address - State:PA
Mailing Address - Zip Code:19025-1009
Mailing Address - Country:US
Mailing Address - Phone:609-792-3237
Mailing Address - Fax:
Practice Address - Street 1:770 MILES RD UNIT 2
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-1950
Practice Address - Country:US
Practice Address - Phone:609-792-3237
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty