NPIMap

Organization Active NPI

Pediatric Dental Assoc LTD

  • Dentist
  • Southampton, PA
National Provider Identifier
1902961899
Registry record updated May 30, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DS028803L Issued in PA
Legal business name
PEDIATRIC DENTAL ASSOC LTD
Practice address
928 Jaymor Road
Suite 130a
Southampton, PA 18966
Phone
(215) 942-7300
Fax
(215) 942-7386
NPI assigned
Dec 22, 2006
Organization subpart
Yes
Parent organization
PEDIATRIC DENTAL ASSOCIATES LTDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 30, 2008

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

Authorized official

Name
Michael S Rosenbaum, DMD
Title
Partner
Phone
(215) 743-3700

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X DS025205L PA
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X DS028803L PA Primary

Addresses

Primary practice location

928 Jaymor Road
Suite 130a
Southampton, PA 18966

Mailing address

6404 Roosevelt Blvd
Phila, PA 19149
Phone (215) 743-3700

National Provider Directory

National Provider Directory
Tax ID family
Pediatric Dental Assoc7 organizations share this tax ID, including this one
Part of
Pediatric Dental Assoc

Other organizations with this tax ID 6

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

NPI Registry JSON

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

{
    "created_epoch": "1166745600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212105600000",
    "number": "1902961899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6404 ROOSEVELT BLVD",
            "city": "PHILA",
            "state": "PA",
            "postal_code": "19149",
            "telephone_number": "215-743-3700",
            "fax_number": "215-743-3715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "928 JAYMOR ROAD",
            "address_2": "SUITE 130A",
            "city": "SOUTHAMPTON",
            "state": "PA",
            "postal_code": "18966",
            "telephone_number": "215-942-7300",
            "fax_number": "215-942-7386"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC DENTAL ASSOC LTD",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PEDIATRIC DENTAL ASSOCIATES LTD",
        "enumeration_date": "2006-12-22",
        "last_updated": "2008-05-30",
        "status": "A",
        "authorized_official_last_name": "ROSENBAUM",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "215-743-3700",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "PA",
            "license": "DS025205L",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "PA",
            "license": "DS028803L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southampton, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 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.