Organization
PREMIER DENTAL OF EDGMONT SQUARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIKE COLE (VP INSURANCE PLAN MANAGEMENT)
(941) 955-3150
Entity
Organization
Contact information
Practice address
4753 W CHESTER PIKE, NEWTOWN SQUARE, PA 19073-2212
(484) 424-0078
Mailing address
4753 W CHESTER PIKE, NEWTOWN SQUARE, PA 19073-2212
(484) 424-0078
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
PA
Other
Enumeration date
03/21/2017
Last updated
04/24/2017
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