Provider Demographics
NPI:1417467945
Name:COVENTRY DENTISTRY LLC
Entity type:Organization
Organization Name:COVENTRY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRYSTLE
Authorized Official - Middle Name:H
Authorized Official - Last Name:CHUONG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:610-385-0022
Mailing Address - Street 1:957 BEN FRANKLIN HWY W
Mailing Address - Street 2:
Mailing Address - City:DOUGLASSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19518-1037
Mailing Address - Country:US
Mailing Address - Phone:610-385-0022
Mailing Address - Fax:610-385-0025
Practice Address - Street 1:2317 POTTSTOWN PIKE
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19465-8722
Practice Address - Country:US
Practice Address - Phone:484-985-8337
Practice Address - Fax:484-985-8249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-11
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-022827L122300000X
PADS-028367L122300000X
1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty