# INDIAN VALLEY DENTAL ASSOCIATES

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Indian Valley Dental Associates
- **Organization subpart:** No

## Provider details

- **NPI number:** 1760558894
- **Authorized official:** DR. SPENCER JARED GROSSMAN DMD (OWNER)
- **Authorized official phone:** (215) 704-4546

## Contact information

- **Practice address:** 601 E BROAD ST, SUITE \#200, SOUDERTON, PA 18964-1263
- **Practice address phone:** (215) 723-5531
- **Practice address fax:** (215) 721-9119
- **Mailing address:** 601 E BROAD ST, SUITE \#200, SOUDERTON, PA 18964-1263
- **Mailing address phone:** (215) 723-5531
- **Mailing address fax:** (215) 721-9119

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | DS021793L | PA | Yes |

## Other

- **Enumeration date:** 11/28/2006
- **Last updated:** 02/10/2024