Organization
MODERN DENTAL PROFESSIONALS PHILADELPHA PC
Active
Other names
Pro-dent
Organization subpart
No
Provider details
NPI number
Authorized official
LAWRENCE PAUL (OWNER)
(610) 459-0845
Entity
Organization
Contact information
Practice address
1440 CONCHESTER HWY, BOOTHWYN, PA 19061-2124
(610) 459-0845
Mailing address
1440 CONCHESTER HWY, BOOTHWYN, PA 19061-2124
(610) 459-0845
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
22D102138300
PA
Other
Enumeration date
12/04/2006
Last updated
08/22/2020
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