Provider Demographics
NPI:1871706168
Name:JOSEPH B. ICENHOWER, JE, DMD,PC
Entity type:Organization
Organization Name:JOSEPH B. ICENHOWER, JE, DMD,PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:B
Authorized Official - Last Name:ICENHOWER
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:610-666-5118
Mailing Address - Street 1:P.O. BOX 402
Mailing Address - Street 2:1408 EGYPT RD
Mailing Address - City:OAKS
Mailing Address - State:PA
Mailing Address - Zip Code:19456-0402
Mailing Address - Country:US
Mailing Address - Phone:610-666-5118
Mailing Address - Fax:610-666-5088
Practice Address - Street 1:1408 EGYPT RD
Practice Address - Street 2:
Practice Address - City:OAKS
Practice Address - State:PA
Practice Address - Zip Code:19456-0402
Practice Address - Country:US
Practice Address - Phone:610-666-5118
Practice Address - Fax:610-666-5088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-019924-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty