Healthcare Provider Details

I. General information

NPI: 1568650166
Provider Name (Legal Business Name): PRINCE OFOSU-MENSAH DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 04/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 SNYDER AVE
PHILADELPHIA PA
19148-2419
US

IV. Provider business mailing address

432 N 6TH ST
PHILADELPHIA PA
19123-4004
US

V. Phone/Fax

Practice location:
  • Phone: 215-334-4900
  • Fax: 215-334-9721
Mailing address:
  • Phone: 215-925-2400
  • Fax: 215-925-9162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS037177
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: