Provider Demographics
NPI:1053541474
Name:HAVERFORD DENTAL P.C.
Entity type:Organization
Organization Name:HAVERFORD DENTAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ONWER/ DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VICKY
Authorized Official - Middle Name:CHANG
Authorized Official - Last Name:ARTHUR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:215-477-8800
Mailing Address - Street 1:1215 GULPH CREEK DR
Mailing Address - Street 2:
Mailing Address - City:RADNOR
Mailing Address - State:PA
Mailing Address - Zip Code:19087-4687
Mailing Address - Country:US
Mailing Address - Phone:215-477-8800
Mailing Address - Fax:215-477-8800
Practice Address - Street 1:1025 N 66TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19151-3104
Practice Address - Country:US
Practice Address - Phone:215-477-8800
Practice Address - Fax:215-477-8800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-20
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS027078L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty