Provider Demographics
NPI:1588896815
Name:PENNDIOS, LLC
Entity type:Organization
Organization Name:PENNDIOS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:DACHOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:215-938-7860
Mailing Address - Street 1:1650 HUNTINGDON PIKE
Mailing Address - Street 2:SUITE 219
Mailing Address - City:MEADOWBROOK
Mailing Address - State:PA
Mailing Address - Zip Code:19046-8004
Mailing Address - Country:US
Mailing Address - Phone:215-938-7860
Mailing Address - Fax:
Practice Address - Street 1:1650 HUNTINGDON PIKE
Practice Address - Street 2:SUITE 219
Practice Address - City:MEADOWBROOK
Practice Address - State:PA
Practice Address - Zip Code:19046-8004
Practice Address - Country:US
Practice Address - Phone:215-938-7860
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-20
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS024726L261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT88983Medicare UPIN