Provider Demographics
NPI:1124126891
Name:POTTSTOWN DENTAL PROFESSIONALS LLC
Entity type:Organization
Organization Name:POTTSTOWN DENTAL PROFESSIONALS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:SANSONE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:610-326-8785
Mailing Address - Street 1:933 N CHARLOTTE ST
Mailing Address - Street 2:SUITE 2D
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464
Mailing Address - Country:US
Mailing Address - Phone:610-326-8785
Mailing Address - Fax:610-326-7043
Practice Address - Street 1:933 N CHARLOTTE ST
Practice Address - Street 2:SUITE 2D
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464
Practice Address - Country:US
Practice Address - Phone:610-326-8785
Practice Address - Fax:610-326-7043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADX020446R122300000X
PADS028302L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty