Healthcare Provider Details

I. General information

NPI: 1437410727
Provider Name (Legal Business Name): JILL JULIANNA BRESLER DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JILL JULIANNA SETTER DMD

II. Dates (important events)

Enumeration Date: 06/03/2012
Last Update Date: 08/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 RIDGE AVE
PHILADELPHIA PA
19128-2446
US

IV. Provider business mailing address

6801 RIDGE AVE
PHILADELPHIA PA
19128-2446
US

V. Phone/Fax

Practice location:
  • Phone: 215-483-6633
  • Fax: 215-969-0215
Mailing address:
  • Phone: 215-483-6633
  • Fax: 215-969-0215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS039100
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: