Georges Bandelac, D.D.S.
Individual provider Active NPI Periodontics · Newtown Square, PA
NPI 1679718332 · NPPES record last updated Jul 20, 2011
Key facts
- NPI
- 1679718332
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Periodontics 1223P0300X
- License
- DS038170 (PA)
- Practice address
- 3855 W Chester Pike
Suite 225
Newtown Square, PA 19073-2304 - Phone
- (484) 420-4643
- Fax
- (484) 420-4645
- NPI assigned
- Dec 10, 2008
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2901019723 | MI | MD | Periodontist |
| DS038170 | PA | MD | Periodontist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Georges Bandelac DDS,PLLC | Periodontics | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | DS038170 | PA | Yes |
| Periodontics | 1223P0300X | 2901019723 | MI |
Addresses
Primary practice location
3855 W Chester Pike
Suite 225
Newtown Square, PA 19073-2304
Mailing address
3855 W Chester Pike
Suite 225
Newtown Square, PA 19073-2304
Phone (484) 420-4643
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All providers in Newtown Square, PA · Periodontics in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 20, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.