Provider Demographics
NPI:1982941746
Name:BLUE BELL ENDODONTICS & DENTAL IMPLANTS, LLC
Entity type:Organization
Organization Name:BLUE BELL ENDODONTICS & DENTAL IMPLANTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:DUTKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:215-628-0610
Mailing Address - Street 1:983 E LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-1030
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:921 PENLLYN BLUE BELL PIKE
Practice Address - Street 2:
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-2163
Practice Address - Country:US
Practice Address - Phone:215-628-0610
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-13
Last Update Date:2013-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental