Provider Demographics
NPI:1194789768
Name:DENTISTRY FOR CHILDREN & ADOLESCENTS,LLC
Entity type:Organization
Organization Name:DENTISTRY FOR CHILDREN & ADOLESCENTS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HENRIETTA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DONOHUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-237-9070
Mailing Address - Street 1:2114 MACDADE BLVD
Mailing Address - Street 2:
Mailing Address - City:HOLMES
Mailing Address - State:PA
Mailing Address - Zip Code:19043-1408
Mailing Address - Country:US
Mailing Address - Phone:610-237-9070
Mailing Address - Fax:610-237-0117
Practice Address - Street 1:2114 MACDADE BLVD
Practice Address - Street 2:
Practice Address - City:HOLMES
Practice Address - State:PA
Practice Address - Zip Code:19043-1408
Practice Address - Country:US
Practice Address - Phone:610-237-9070
Practice Address - Fax:610-237-0117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty