Healthcare Provider Details

I. General information

NPI: 1245364579
Provider Name (Legal Business Name): DENTISTRY AT 1818 MARKET STREET
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 MARKET ST SUITE 100
PHILADELPHIA PA
19103-3638
US

IV. Provider business mailing address

1818 MARKET ST SUITE 100
PHILADELPHIA PA
19103-3638
US

V. Phone/Fax

Practice location:
  • Phone: 215-567-2666
  • Fax: 215-561-6084
Mailing address:
  • Phone: 215-567-2666
  • Fax: 215-561-6084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. NICOLE MOSLEY
Title or Position: RECEPTIONIST
Credential:
Phone: 215-567-2666