Healthcare Provider Details

I. General information

NPI: 1104538941
Provider Name (Legal Business Name): DANIEL OWUSU-ANTWI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2022
Last Update Date: 11/13/2023
Certification Date: 11/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 E WADSWORTH AVE
PHILADELPHIA PA
19150-1605
US

IV. Provider business mailing address

1501 E WADSWORTH AVE
PHILADELPHIA PA
19150-1605
US

V. Phone/Fax

Practice location:
  • Phone: 215-914-8188
  • Fax: 215-702-6080
Mailing address:
  • Phone: 215-914-8188
  • Fax: 215-702-6080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS043953
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: