NPIMap

Organization Active NPI

Eagle Crest Pediatric Dentistry

  • Pediatric Dentistry
  • Havertown, PA
National Provider Identifier
1326392846
Registry record updated Oct 3, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
EAGLE CREST PEDIATRIC DENTISTRY
Practice address
31 S Eagle Rd
Suite 100
Havertown, PA 19083-3340
Phone
(484) 454-3568
Fax
(484) 454-3582
NPI assigned
Nov 6, 2012
Last updated
Oct 3, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2014

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

Authorized official

Name
Rose Wadenya, DMDNPI 1386978583
Title
Owner / Pediatric Dentist
Phone
(484) 454-3568

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X NU Primary

Addresses

Primary practice location

31 S Eagle Rd
Suite 100
Havertown, PA 19083-3340

Mailing address

31 S Eagle Rd
Suite 100
Havertown, PA 19083-3340
Phone (484) 454-3568

National Provider Directory

National Provider Directory

Locations

31 S Eagle Rd
Ste 100
Havertown, PA 19083
Phone (484) 454-3568

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1352160000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1412294400000",
    "number": "1326392846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31 S EAGLE RD",
            "address_2": "SUITE 100",
            "city": "HAVERTOWN",
            "state": "PA",
            "postal_code": "190833340",
            "telephone_number": "484-454-3568",
            "fax_number": "484-454-3582"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31 S EAGLE RD",
            "address_2": "SUITE 100",
            "city": "HAVERTOWN",
            "state": "PA",
            "postal_code": "190833340",
            "telephone_number": "484-454-3568",
            "fax_number": "484-454-3582"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAGLE CREST PEDIATRIC DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-06",
        "last_updated": "2014-10-03",
        "status": "A",
        "authorized_official_last_name": "WADENYA",
        "authorized_official_first_name": "ROSE",
        "authorized_official_title_or_position": "OWNER / PEDIATRIC DENTIST",
        "authorized_official_telephone_number": "484-454-3568",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Havertown, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2014; 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.