Provider Demographics
NPI:1528325008
Name:EAGLE FAMILY DENTISTRY, LLC
Entity type:Organization
Organization Name:EAGLE FAMILY DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:DELLA CROCE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:215-200-7883
Mailing Address - Street 1:72 POTTSTOWN PIKE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CHESTER SPRINGS
Mailing Address - State:PA
Mailing Address - Zip Code:19425-9564
Mailing Address - Country:US
Mailing Address - Phone:610-458-5165
Mailing Address - Fax:
Practice Address - Street 1:72 POTTSTOWN PIKE
Practice Address - Street 2:SUITE 203
Practice Address - City:CHESTER SPRINGS
Practice Address - State:PA
Practice Address - Zip Code:19425-9564
Practice Address - Country:US
Practice Address - Phone:610-458-5165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-20
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental