Healthcare Provider Details

I. General information

NPI: 1386638716
Provider Name (Legal Business Name): ALEGRIA DAGOSTINO DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 03/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6404 ROOSEVELT BLVD
PHILADELPHIA PA
19149-2943
US

IV. Provider business mailing address

6404 ROOSEVELT BLVD
PHILADELPHIA PA
19149-2943
US

V. Phone/Fax

Practice location:
  • Phone: 215-743-3700
  • Fax: 215-743-3706
Mailing address:
  • Phone: 215-743-3700
  • Fax: 215-743-3706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDS029850L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: