Provider Demographics
NPI:1124767421
Name:FAMILY DENTISTRY ALLENTOWN, LLC DBA CEDAR CREST DENTISTRY
Entity type:Organization
Organization Name:FAMILY DENTISTRY ALLENTOWN, LLC DBA CEDAR CREST DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:M
Authorized Official - Last Name:TUNO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-412-7973
Mailing Address - Street 1:1110 S CEDAR CREST BLVD
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-7901
Mailing Address - Country:US
Mailing Address - Phone:610-433-2046
Mailing Address - Fax:
Practice Address - Street 1:1110 S CEDAR CREST BLVD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-7901
Practice Address - Country:US
Practice Address - Phone:610-433-2046
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-03
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1023088408OtherINDIVIDUAL NPI