Provider Demographics
NPI:1730924366
Name:FA5 ASSOCIATES LLC
Entity type:Organization
Organization Name:FA5 ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:RICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-803-3745
Mailing Address - Street 1:9 HERALD PL
Mailing Address - Street 2:
Mailing Address - City:ASTON
Mailing Address - State:PA
Mailing Address - Zip Code:19014-2103
Mailing Address - Country:US
Mailing Address - Phone:610-803-3745
Mailing Address - Fax:215-389-1036
Practice Address - Street 1:1 CRESCENT DR STE 300
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19112-1015
Practice Address - Country:US
Practice Address - Phone:215-389-3161
Practice Address - Fax:215-389-1036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty