Provider Demographics
NPI:1841454030
Name:JOHN T. WAITE, D.D.S.
Entity type:Organization
Organization Name:JOHN T. WAITE, D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:T
Authorized Official - Last Name:WAITE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:610-394-3363
Mailing Address - Street 1:282 N LANSDOWNE AVE
Mailing Address - Street 2:
Mailing Address - City:LANSDOWNE
Mailing Address - State:PA
Mailing Address - Zip Code:19050-1101
Mailing Address - Country:US
Mailing Address - Phone:610-394-3363
Mailing Address - Fax:610-259-7785
Practice Address - Street 1:282 N LANSDOWNE AVE
Practice Address - Street 2:
Practice Address - City:LANSDOWNE
Practice Address - State:PA
Practice Address - Zip Code:19050-1101
Practice Address - Country:US
Practice Address - Phone:610-394-3363
Practice Address - Fax:610-259-7785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026358L261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental