Healthcare Provider Details

I. General information

NPI: 1770592594
Provider Name (Legal Business Name): CARL L TINKLEMAN DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 S 17TH STREET SUITE 1806
PHILADELPHIA PA
19103
US

IV. Provider business mailing address

255 S 17TH STREET SUITE 1806
PHILADELPHIA PA
19103
US

V. Phone/Fax

Practice location:
  • Phone: 215-735-1131
  • Fax: 215-735-9892
Mailing address:
  • Phone: 215-735-1131
  • Fax: 215-735-9892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS030806L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS028500L
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS15962L
License Number StatePA

VIII. Authorized Official

Name: DR. JOSHUA B WOLGIN
Title or Position: CO PRESIDENT
Credential: DMD
Phone: 215-735-1131