Provider Demographics
NPI:1548472368
Name:DENTAL PROFESSIONALS OF PENNSYLVANIA, P.C.
Entity type:Organization
Organization Name:DENTAL PROFESSIONALS OF PENNSYLVANIA, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAULICH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:217-651-4669
Mailing Address - Street 1:833 N BETHLEHEM PIKE
Mailing Address - Street 2:STE B
Mailing Address - City:AMBLER
Mailing Address - State:PA
Mailing Address - Zip Code:19002-2533
Mailing Address - Country:US
Mailing Address - Phone:215-646-8887
Mailing Address - Fax:215-646-8891
Practice Address - Street 1:833 N BETHLEHEM PIKE
Practice Address - Street 2:STE B
Practice Address - City:AMBLER
Practice Address - State:PA
Practice Address - Zip Code:19002-2533
Practice Address - Country:US
Practice Address - Phone:215-646-8887
Practice Address - Fax:215-646-8891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026193L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty