Organization
LEHIGH VALLEY SUBURBAN DENTAL ASSOC LTD
Active
Other names
Suburban Dental Associates
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK B DIAMOND DMD (PARTNER MANAGER)
(610) 820-9900
Entity
Organization
Contact information
Practice address
1621 N CEDARCREST BLVD, SUITE 117, ALLENTOWN, PA 18104
(610) 820-9900
(610) 820-9922
Mailing address
1621 N CEDARCREST BLVD, SUITE 117, ALLENTOWN, PA 18104
(610) 820-9900
(610) 820-9922
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DS017121L
PA
122300000X
Dentist
DS019952L
PA
122300000X
Dentist
Primary
DS020511L
PA
122300000X
Dentist
DS022795L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10274
AETNA
PA
01
—
414531
UNITED CONCORDIA UCCI
PA
Enumeration date
08/30/2006
Last updated
08/22/2020
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