Provider Demographics
NPI:1336437516
Name:GEORGES BANDELAC DDS,PLLC
Entity type:Organization
Organization Name:GEORGES BANDELAC DDS,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGES
Authorized Official - Middle Name:
Authorized Official - Last Name:BANDELAC
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:646-258-4151
Mailing Address - Street 1:3855 W CHESTER PIKE
Mailing Address - Street 2:SUITE 225
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-2304
Mailing Address - Country:US
Mailing Address - Phone:484-420-4643
Mailing Address - Fax:484-420-4645
Practice Address - Street 1:3855 W CHESTER PIKE
Practice Address - Street 2:SUITE 225
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-2304
Practice Address - Country:US
Practice Address - Phone:484-420-4643
Practice Address - Fax:484-420-4645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-21
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty