Healthcare Provider Details

I. General information

NPI: 1205093481
Provider Name (Legal Business Name): MICHAEL E. PLISKIN PHD,DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2008
Last Update Date: 05/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3223 N BROAD ST TEMPLE UNIVERSITY KORNBERG SCHOOL OF DENTISTRY
PHILADELPHIA PA
19140-5007
US

IV. Provider business mailing address

3223 N BROAD ST TEMPLE UNIVERSITY KORNBERG SCHOOL OF DENTISTRY
PHILADELPHIA PA
19140-5007
US

V. Phone/Fax

Practice location:
  • Phone: 215-707-2913
  • Fax: 215-707-5885
Mailing address:
  • Phone: 215-707-2913
  • Fax: 215-707-5885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS017276L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: