Provider Demographics
NPI:1932779196
Name:BRANDYWINE DENTAL OF THE LEHIGH VALLEY, LLC
Entity Type:Organization
Organization Name:BRANDYWINE DENTAL OF THE LEHIGH VALLEY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:KUN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:610-682-6386
Mailing Address - Street 1:9655 LONGSWAMP RD
Mailing Address - Street 2:
Mailing Address - City:MERTZTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19539-8800
Mailing Address - Country:US
Mailing Address - Phone:610-682-6386
Mailing Address - Fax:610-682-6387
Practice Address - Street 1:9655 LONGSWAMP RD
Practice Address - Street 2:
Practice Address - City:MERTZTOWN
Practice Address - State:PA
Practice Address - Zip Code:19539-8800
Practice Address - Country:US
Practice Address - Phone:610-682-6386
Practice Address - Fax:610-682-6387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-30
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty