# JEFFREY P DECROSTA DDS PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1801097811
- **Authorized official:** MRS. KATHARINE JOAN DECROSTA (ADMINISTRATOR)
- **Authorized official phone:** (610) 691-6200

## Contact information

- **Practice address:** 627 W BROAD ST, BETHLEHEM, PA 18018-5220
- **Practice address phone:** (610) 691-6200
- **Practice address fax:** (610) 691-1840
- **Mailing address:** 627 W BROAD ST, BETHLEHEM, PA 18018-5220
- **Mailing address phone:** (610) 691-6200
- **Mailing address fax:** (610) 691-1840

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 05/29/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 340380 | UNITED CONCORDIA | PA |