Provider Demographics
NPI:1841808177
Name:OPERA HOUSE PARKESBURG DENTAL, LLC
Entity type:Organization
Organization Name:OPERA HOUSE PARKESBURG DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:FELIX
Authorized Official - Last Name:DESANTIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:610-220-9303
Mailing Address - Street 1:3162 STILL WOOD LANE
Mailing Address - Street 2:
Mailing Address - City:GARNET VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19060
Mailing Address - Country:US
Mailing Address - Phone:610-220-9303
Mailing Address - Fax:610-497-3792
Practice Address - Street 1:358 WEST FIRST AVENUE
Practice Address - Street 2:
Practice Address - City:PARKESBURG
Practice Address - State:PA
Practice Address - Zip Code:19365
Practice Address - Country:US
Practice Address - Phone:610-857-9244
Practice Address - Fax:610-497-3792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-22
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental