Provider Demographics
NPI:1144302357
Name:ALLENTOWN FAMILY DENTAL CENTER, LLC
Entity type:Organization
Organization Name:ALLENTOWN FAMILY DENTAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FENNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-868-6200
Mailing Address - Street 1:8918 WOODYARD RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-4204
Mailing Address - Country:US
Mailing Address - Phone:301-868-6200
Mailing Address - Fax:301-868-4881
Practice Address - Street 1:8918 WOODYARD RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-4204
Practice Address - Country:US
Practice Address - Phone:301-868-6200
Practice Address - Fax:301-868-4881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty