Provider Demographics
NPI:1588930648
Name:MEDIA DENTAL CARE
Entity type:Organization
Organization Name:MEDIA DENTAL CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXCUTIVE
Authorized Official - Prefix:DR
Authorized Official - First Name:HONGMEI
Authorized Official - Middle Name:
Authorized Official - Last Name:YANG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:610-594-2000
Mailing Address - Street 1:3309 EDGMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:19015-2830
Mailing Address - Country:US
Mailing Address - Phone:610-876-8038
Mailing Address - Fax:610-876-2910
Practice Address - Street 1:3309 EDGMONT AVE
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:PA
Practice Address - Zip Code:19015-2830
Practice Address - Country:US
Practice Address - Phone:610-876-8038
Practice Address - Fax:610-876-2910
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDIA DENTAL CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-22
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS036818122300000X
PADS036849122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty