Organization
GD PA COLLEGEVILLE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHAD HENDRICKS (CREDENTIALING)
(612) 859-0444
Entity
Organization
Contact information
Practice address
555 SECOND AVE STE D-500, COLLEGEVILLE, PA 19426-3641
(610) 409-9370
Mailing address
555 SECOND AVE STE D-500, COLLEGEVILLE, PA 19426-3641
(610) 409-9370
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
10/09/2024
Last updated
10/09/2024
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