Provider Demographics
NPI:1366944639
Name:DENTAL EXCELLENCE OF HATFIELD
Entity type:Organization
Organization Name:DENTAL EXCELLENCE OF HATFIELD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:LISANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAISONET
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:215-828-2789
Mailing Address - Street 1:461 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HATFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19440-2511
Mailing Address - Country:US
Mailing Address - Phone:215-855-1438
Mailing Address - Fax:
Practice Address - Street 1:461 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HATFIELD
Practice Address - State:PA
Practice Address - Zip Code:19440-2511
Practice Address - Country:US
Practice Address - Phone:215-855-1438
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-02
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029728-L261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental