CCD Wayne Family Dentistry, LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

CCD WAYNE FAMILY DENTISTRY, LLC

Practice address

415 E Lancaster Ave
Wayne, PA 19087-4202

Phone

(610) 688-4578

NPI assigned

Dec 20, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Beth Walsh

Title

Director of Operations

Phone

(610) 842-5421

Specialties & licenses 1

Addresses

Other names 1

• Wayne Family Dentistry Doing business as

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kenneth Allen Fetter Sr., DMD

  • Dentist
  • Wayne, PA
  • NPI 1255429544
  NPD (past)
• Dallas Lee Pulliam Jr., DMD

  • Dentist
  • Wayne, PA
  • NPI 1538257829
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1576800000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597795200000",
    "number": "1124667159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 E LANCASTER AVE",
            "city": "WAYNE",
            "state": "PA",
            "postal_code": "190874202",
            "telephone_number": "610-688-4578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 E LANCASTER AVE",
            "city": "WAYNE",
            "state": "PA",
            "postal_code": "190874202",
            "telephone_number": "610-688-4578"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CCD WAYNE FAMILY DENTISTRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-20",
        "last_updated": "2020-08-19",
        "certification_date": "2020-08-19",
        "status": "A",
        "authorized_official_last_name": "WALSH",
        "authorized_official_first_name": "BETH",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "610-842-5421",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wayne Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Rachael Carr
• Bonnie Frank Carter, PH.D.
• Meghan Cataldi
• Catherine Weng, LLC
• Daniella Cavenagh, PHD
• Center for Vein Restoration PA PLLC
• Centerpiece Home Care LLC
• Charan Tony Chadha, MPT
• Rebecca Chadwick
• Mineela Jayapriya Chand, B.SC., M.DIV., LMFT

• All providers in Wayne, PA
• General Practice Dentistry in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.