Provider Demographics
NPI:1316454150
Name:PEDIATRIC DENTISTRY OF LOWER MERION
Entity type:Organization
Organization Name:PEDIATRIC DENTISTRY OF LOWER MERION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:HORCHOS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:267-303-7289
Mailing Address - Street 1:18 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BELMONT HILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1812
Mailing Address - Country:US
Mailing Address - Phone:267-303-7289
Mailing Address - Fax:
Practice Address - Street 1:42 W LANCASTER AVE STE 100
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:PA
Practice Address - Zip Code:19003-1331
Practice Address - Country:US
Practice Address - Phone:610-642-3417
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-02
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1225045974OtherINDIVIDUAL NPI#