Provider Demographics
NPI:1912436874
Name:KREIDER, BIANCA (DMD)
Entity Type:Individual
Prefix:DR
First Name:BIANCA
Middle Name:
Last Name:KREIDER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:741 SPRING MILL AVE
Mailing Address - Street 2:
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-1953
Mailing Address - Country:US
Mailing Address - Phone:240-441-6555
Mailing Address - Fax:
Practice Address - Street 1:6801 RIDGE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-2446
Practice Address - Country:US
Practice Address - Phone:215-483-6633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-05
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYUNKNOWN122300000X
CO002039181223P0221X
PADS0429181223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist