Provider Demographics
NPI:1972376333
Name:CHRISTMAS CITY DENTISTRY PLLC
Entity type:Organization
Organization Name:CHRISTMAS CITY DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:OLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:610-304-5359
Mailing Address - Street 1:3859 NAZARETH PIKE
Mailing Address - Street 2:SUITES 202 AND 203
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18020-1102
Mailing Address - Country:US
Mailing Address - Phone:610-419-0088
Mailing Address - Fax:610-419-0372
Practice Address - Street 1:3859 NAZARETH PIKE
Practice Address - Street 2:SUITES 202 AND 203
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18020
Practice Address - Country:US
Practice Address - Phone:610-419-0088
Practice Address - Fax:610-419-0372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-06
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental