Healthcare Provider Details

I. General information

NPI: 1598177107
Provider Name (Legal Business Name): RACHEL BRESLER DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2014
Last Update Date: 07/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 RIDGE AVE
PHILADELPHIA PA
19128
US

IV. Provider business mailing address

6801 RIDGE AVE
PHILADELPHIA PA
19128-2446
US

V. Phone/Fax

Practice location:
  • Phone: 215-483-6633
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDS039958
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: