Provider Demographics
NPI:1982269718
Name:THORNDALE DENTAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:THORNDALE DENTAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:PAIGE
Authorized Official - Middle Name:E
Authorized Official - Last Name:D'ANGELO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-828-8986
Mailing Address - Street 1:3105 ZINN RD
Mailing Address - Street 2:
Mailing Address - City:THORNDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19372-1131
Mailing Address - Country:US
Mailing Address - Phone:610-384-2541
Mailing Address - Fax:
Practice Address - Street 1:3105 ZINN RD
Practice Address - Street 2:
Practice Address - City:THORNDALE
Practice Address - State:PA
Practice Address - Zip Code:19372-1131
Practice Address - Country:US
Practice Address - Phone:610-384-2541
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-07
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental