Provider Demographics
NPI:1285066373
Name:FAMILY DENTISTRY OF ALLENTOWN, P.C.
Entity type:Organization
Organization Name:FAMILY DENTISTRY OF ALLENTOWN, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:POLLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:732-914-1039
Mailing Address - Street 1:3300 LEHIGH ST
Mailing Address - Street 2:SUITE 716
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-7041
Mailing Address - Country:US
Mailing Address - Phone:610-295-6035
Mailing Address - Fax:610-709-9881
Practice Address - Street 1:3300 LEHIGH ST
Practice Address - Street 2:SUITE 716
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-7041
Practice Address - Country:US
Practice Address - Phone:610-295-6035
Practice Address - Fax:610-709-9881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-31
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0382251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty