MEDICARE: DR. SIERRA ROSE VAN DEN DRIES DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DS041346	PA

General Provider Information

NPI Number	:	1649790247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SIERRA ROSE VAN DEN DRIES DMD

Provider Business Mailing Address
First Line	:	3400 CIVIC CENTER BLVD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-5127
Country	:	US
Telephone Number	:	215-662-8221
Fax Number	:

Provider Business Practice Location Address
First Line	:	3400 CIVIC CENTER BLVD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-5127
Country	:	US
Telephone Number	:	215-662-8221
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2017
Last Update Date	:	12/02/2025

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