MEDICARE: DR. OSCAR GOREN D.M.D.

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	122300000X	Dentist	DS-19920-L	PA

General Provider Information

NPI Number	:	1750360442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OSCAR GOREN D.M.D.

Provider Business Mailing Address
First Line	:	2412 RHAWN ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19152-3324
Country	:	US
Telephone Number	:	215-332-5259
Fax Number	:

Provider Business Practice Location Address
First Line	:	2412 RHAWN ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19152-3324
Country	:	US
Telephone Number	:	215-332-5259
Fax Number	:

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

Provider Enumeration Date	:	01/11/2006
Last Update Date	:	07/08/2007

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