Provider Demographics
NPI:1104588730
Name:DAVID MACONI DDS LLC
Entity type:Organization
Organization Name:DAVID MACONI DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:MACONI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:609-477-2290
Mailing Address - Street 1:195 E CHELSEA CIR
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-2110
Mailing Address - Country:US
Mailing Address - Phone:609-477-2290
Mailing Address - Fax:
Practice Address - Street 1:810 DARBY RD
Practice Address - Street 2:
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-4607
Practice Address - Country:US
Practice Address - Phone:610-853-6602
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-11
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental