Provider Demographics
NPI:1699300475
Name:ACADEMY OF MODERN IMPLANTS & DENTISTRY
Entity type:Organization
Organization Name:ACADEMY OF MODERN IMPLANTS & DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COREY
Authorized Official - Middle Name:
Authorized Official - Last Name:RAYMOND
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:484-685-3933
Mailing Address - Street 1:700 S HENDERSON RD STE 306
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-4208
Mailing Address - Country:US
Mailing Address - Phone:484-685-3933
Mailing Address - Fax:
Practice Address - Street 1:700 S HENDERSON RD STE 306
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-4208
Practice Address - Country:US
Practice Address - Phone:484-685-3933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-11
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental