NPIMap

Organization Active NPI

Dental Professionals of Pennsylvania, P.C.

  • General Practice Dentistry
  • Yardley, PA
National Provider Identifier
1760085583
Registry record updated Nov 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
DENTAL PROFESSIONALS OF PENNSYLVANIA, P.C.
Practice address
404 Floral Vale Blvd
Yardley, PA 19067-5526
Phone
(215) 579-2500
NPI assigned
Nov 17, 2020
Organization subpart
Yes
Parent organization
DENTAL PROFESSIONALS OF PENNSYLVANIA, P.C.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 17, 2020

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

Authorized official

Name
Tabatha Lemke
Title
Credentialing Coordinator
Phone
(217) 540-6078

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

404 Floral Vale Blvd
Yardley, PA 19067-5526

Mailing address

404 Floral Vale Blvd
Yardley, PA 19067-5526

Other names 1

  • Shady Brook Family Dental Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Dental Professionals of Pennsylvania PC40 organizations share this tax ID, including this one
Part of
Dental Professionals of Pennsylvania PC

Other organizations with this tax ID 39

Organizations that report the same tax identification number in the National Provider Directory.

View all 39

Practitioners & affiliated clinicians

Practitioners 4

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": "1605571200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605571200000",
    "number": "1760085583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "404 FLORAL VALE BLVD",
            "city": "YARDLEY",
            "state": "PA",
            "postal_code": "190675526"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 FLORAL VALE BLVD",
            "city": "YARDLEY",
            "state": "PA",
            "postal_code": "190675526",
            "telephone_number": "215-579-2500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL PROFESSIONALS OF PENNSYLVANIA, P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DENTAL PROFESSIONALS OF PENNSYLVANIA, P.C.",
        "enumeration_date": "2020-11-17",
        "last_updated": "2020-11-17",
        "certification_date": "2020-11-17",
        "status": "A",
        "authorized_official_last_name": "LEMKE",
        "authorized_official_first_name": "TABATHA",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "217-540-6078"
    },
    "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": "Shady Brook Family Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Yardley, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 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.