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Organization
WHITEHALL DENTAL ASSOC
Active
Organization
WHITEHALL DENTAL ASSOC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NIDAL YACOUB DMD, MDS (OWNER/DENTIST)
(610) 360-9625
Entity
Organization
Contact information
Practice address
450 PERSHING BLVD, WHITEHALL, PA 18052-6452
(610) 434-6796
(610) 434-6671
Mailing address
450 PERSHING BLVD, WHITEHALL, PA 18052-6452
(610) 434-6796
(610) 434-6671
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DS031269L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0018794480004
—
PA
05
—
1799436
—
PA
Enumeration date
10/20/2005
Last updated
03/21/2018
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