MEDICARE: PHILADELPHIA DENTAL LASER & COSMETIC DENTISTRY LLC

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

General Provider Information

NPI Number	:	1699237602
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHILADELPHIA DENTAL LASER & COSMETIC DENTISTRY LLC

Provider Business Mailing Address
First Line	:	3016 TOWNSHIP LINE RD
Second Line	:
City	:	DREXEL HILL
State	:	PA
Zip	:	19026-1823
Country	:	US
Telephone Number	:	610-888-3291
Fax Number	:	484-454-3744

Provider Business Practice Location Address
First Line	:	3016 TOWNSHIP LINE RD
Second Line	:
City	:	DREXEL HILL
State	:	PA
Zip	:	19026-1823
Country	:	US
Telephone Number	:	610-888-3291
Fax Number	:	484-454-3744

Authorized Official
Title or Position	:	CO-OWNER
Name	:	DR. BARBARA ANN TARNOSKI
Credential	:	DMD
Telephone Number	:	610-888-3291

Provider Enumeration Date	:	04/01/2019
Last Update Date	:	04/01/2019

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