NPIMap

Organization Active NPI

Dynamic Modern Dentistry

  • General Practice Dentistry
  • Glenside, PA
National Provider Identifier
1578714812
Registry record updated Oct 6, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
DYNAMIC MODERN DENTISTRY
Practice address
230 N Keswick Ave
Glenside, PA 19038-4804
Phone
(215) 885-4252
Fax
(215) 885-7487
NPI assigned
Oct 6, 2008
Last updated
Oct 6, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2008

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

Authorized official

Name
Dr. Susan M Rotzal, DMD, MAGDNPI 1548211063
Title
Partner
Phone
(215) 885-4252

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
General Practice Dentistry 1223G0001X Primary

Addresses

Primary practice location

230 N Keswick Ave
Glenside, PA 19038-4804

Mailing address

230 N Keswick Ave
Glenside, PA 19038-4804
Phone (215) 885-4252

National Provider Directory

National Provider Directory

Locations

230 N Keswick Ave
Glenside, PA 19038
Phone (215) 885-4252

Practitioners & affiliated clinicians

Practitioners 5

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": "1223251200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1223251200000",
    "number": "1578714812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "230 N KESWICK AVE",
            "city": "GLENSIDE",
            "state": "PA",
            "postal_code": "190384804",
            "telephone_number": "215-885-4252",
            "fax_number": "215-885-7487"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "230 N KESWICK AVE",
            "city": "GLENSIDE",
            "state": "PA",
            "postal_code": "190384804",
            "telephone_number": "215-885-4252",
            "fax_number": "215-885-7487"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DYNAMIC MODERN DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-06",
        "last_updated": "2008-10-06",
        "status": "A",
        "authorized_official_last_name": "ROTZAL",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "215-885-4252",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD, MAGD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glenside, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2008; 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.