Organization
DOMENIC BAGLIVO JR D.M.D., P.C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DOMENIC BAGLIVO JR. D.M.D (PRESIDENT)
(610) 642-0259
Entity
Organization
Contact information
Practice address
100 E LANCASTER AVE. SUITE 203W, LANKENAU MEDICAL BUILDING SOUTH, WYNNEWOOD, PA 19096
(610) 642-0259
(610) 896-6405
Mailing address
100 EAST LANCASTER AVENUE, LANKENAU MEDICAL BLDG - SUITE 203W, WYNNEWOOD, PA 19096
(610) 642-0259
(610) 896-6405
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DS-025340-L
PA
Other
Enumeration date
08/12/2010
Last updated
08/12/2010
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