| Indian Valley Dental Associates | |
|
601 E Broad St Suite #200 Souderton PA 18964-1263 | |
| (215) 723-5531 | |
| (215) 721-9119 |
| Full Name | Indian Valley Dental Associates |
|---|---|
| Speciality | Dentist |
| Location | 601 E Broad St, Souderton, Pennsylvania |
| Authorized Official Name and Position | Spencer Jared Grossman (OWNER) |
| Authorized Official Contact | 2157044546 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Indian Valley Dental Associates 601 E Broad St Suite #200 Souderton PA 18964-1263 Ph: (215) 723-5531 | Indian Valley Dental Associates 601 E Broad St Suite #200 Souderton PA 18964-1263 Ph: (215) 723-5531 |
| NPI Number | 1760558894 |
|---|---|
| Provider Enumeration Date | 11/28/2006 |
| Last Update Date | 02/10/2024 |
| Medicare PECOS PAC ID | 6507136587 |
|---|---|
| Medicare Enrollment ID | O20170725000361 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760558894 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | DS021793L (Pennsylvania) | Primary |
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