Provider Demographics
NPI:1023904422
Name:PEDIATRIC DENTISTRY OF NEWTOWN SQUARE, LLC
Entity type:Organization
Organization Name:PEDIATRIC DENTISTRY OF NEWTOWN SQUARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANGAR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:484-473-9645
Mailing Address - Street 1:516 S MEDIA WAY
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-3267
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3475 W CHESTER PIKE STE 220
Practice Address - Street 2:
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-4291
Practice Address - Country:US
Practice Address - Phone:484-473-9645
Practice Address - Fax:484-473-9685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-13
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental