NPIMap

Organization Active NPI

Richboro Family Dentistry LLC

  • General Practice Dentistry
  • Richboro, PA
National Provider Identifier
1508921644
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DS022913L Issued in PA
Legal business name
RICHBORO FAMILY DENTISTRY LLC
Practice address
130 Almshouse Road
Suite Number 500
Richboro, PA 18954
Phone
(215) 322-0440
Fax
(215) 322-3941
NPI assigned
Dec 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Donald G Tedrow, DMDNPI 1609038785
Title
Owner Partner
Phone
(215) 322-0440

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X DS023139L PA
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X DS022913L PA Primary

Addresses

Primary practice location

130 Almshouse Road
Suite Number 500
Richboro, PA 18954

Mailing address

130 Almshouse Road
Suite Number 500
Richboro, PA 18954
Phone (215) 322-0440

Other names 1

  • Dr Glenn Miller and Dr Donald Tedrow Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150804005666 PA DME Supplier - Oral Surgery - Dentist 9537473517 Practice locations: Richboro, PA

National Provider Directory

National Provider Directory

Locations

130 Almshouse Rd
Ste 500
Richboro, PA 18954
Phone (215) 322-0400

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1167177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1508921644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 ALMSHOUSE ROAD",
            "address_2": "SUITE NUMBER 500",
            "city": "RICHBORO",
            "state": "PA",
            "postal_code": "18954",
            "telephone_number": "215-322-0440",
            "fax_number": "215-322-3941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 ALMSHOUSE ROAD",
            "address_2": "SUITE NUMBER 500",
            "city": "RICHBORO",
            "state": "PA",
            "postal_code": "18954",
            "telephone_number": "215-322-0440",
            "fax_number": "215-322-3941"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RICHBORO FAMILY DENTISTRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "TEDROW",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OWNER PARTNER",
        "authorized_official_telephone_number": "215-322-0440",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS023139L",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS022913L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dr Glenn Miller and Dr Donald Tedrow",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Richboro, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.