Organization
BOULEVARD DENTAL ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY MEDIANICK DMD (OWNER)
(610) 775-0321
Entity
Organization
Contact information
Practice address
430 KENHORST BLVD, READING, PA 19611-1830
(610) 775-0321
(610) 777-8884
Mailing address
430 KENHORST BLVD, READING, PA 19611-1830
(610) 775-0321
(610) 777-8884
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
DN017638
PA
1223G0001X
General Practice Dentistry
Primary
DS036510
PA
Other
Enumeration date
06/30/2009
Last updated
07/27/2009
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