| Organization Name: | ELWYN |
| NPI Number: | 1962557314 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DAN REARDON (VICE PRESIDENT FINANCE) |
| Mailing Address: | 111 Elwyn Rd Dental Suite - Maris Building Elwyn |
| State: | PA US |
| Postal Code: | 190634622 |
| Phone Number: | 6108912320 |
| Fax Number: | 6108912321 |
| NPI Enumeration Date: | 01/24/2007 |
| NPI Last Update Date: | 02/16/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |