# CRENTIST PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Ridley Dental Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1649817719
- **Authorized official:** JORDAN KLINKNER (PRESIDENT)
- **Authorized official phone:** (917) 523-9800

## Contact information

- **Practice address:** 1100 MACDADE BLVD, WOODLYN, PA 19094-1322
- **Practice address phone:** (610) 833-1919
- **Mailing address:** 1100 MACDADE BLVD, WOODLYN, PA 19094-1322
- **Mailing address phone:** (610) 833-1919

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 12/07/2019
- **Last updated:** 12/07/2019