Provider Demographics
NPI: | 1871882860 |
---|---|
Name: | LEHIGH VALLEY ENDODONTICS-BETHLEHEM |
Entity type: | Organization |
Organization Name: | LEHIGH VALLEY ENDODONTICS-BETHLEHEM |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OFFICE MANAGER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | LORI |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | SNYDER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 484-821-1333 |
Mailing Address - Street 1: | 2551 BAGLYOS CIR |
Mailing Address - Street 2: | SUITE A-19 |
Mailing Address - City: | BETHLEHEM |
Mailing Address - State: | PA |
Mailing Address - Zip Code: | 18020-8042 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 2551 BAGLYOS CIR |
Practice Address - Street 2: | SUITE A-19 |
Practice Address - City: | BETHLEHEM |
Practice Address - State: | PA |
Practice Address - Zip Code: | 18020-8042 |
Practice Address - Country: | US |
Practice Address - Phone: | 484-821-1333 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2011-03-31 |
Last Update Date: | 2011-03-31 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
PA | DS-030015-L | 1223E0200X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 1223E0200X | Dental Providers | Dentist | Endodontics | Group - Single Specialty |