Healthcare Provider Details

I. General information

NPI: 1790706778
Provider Name (Legal Business Name): PREMIER ENDODONTICS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 12/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 TYSON AVE
PHILADELPHIA PA
19135-1615
US

IV. Provider business mailing address

1700 DEVONSHIRE RD
DRESHER PA
19025-1307
US

V. Phone/Fax

Practice location:
  • Phone: 215-338-0188
  • Fax: 215-338-9076
Mailing address:
  • Phone: 215-657-5158
  • Fax: 215-338-9076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDS061316L
License Number StatePA

VIII. Authorized Official

Name: DR. NEAL APPELSTEIN
Title or Position: OWNER
Credential: DMD
Phone: 215-338-0188