Healthcare Provider Details

I. General information

NPI: 1912687187
Provider Name (Legal Business Name): TEMPLE UNIVERSITY OF THE COMMONWEALTH SYSTEM OF HIGHER EDUCATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2023
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3223 N BROAD ST
PHILADELPHIA PA
19140-5007
US

IV. Provider business mailing address

3223 N BROAD ST
PHILADELPHIA PA
19140-5007
US

V. Phone/Fax

Practice location:
  • Phone: 215-707-2900
  • Fax: 215-707-5885
Mailing address:
  • Phone: 215-707-2900
  • Fax: 215-707-5885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1223X2210X
TaxonomyOrofacial Pain Dentistry
License Number
License Number State

VIII. Authorized Official

Name: CRISTINA VALENTIN
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 215-707-0297