Healthcare Provider Details

I. General information

NPI: 1619263522
Provider Name (Legal Business Name): TEMPLE UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E LEHIGH AVE
PHILADELPHIA PA
19125-1012
US

IV. Provider business mailing address

433 DORCHESTER DR
DELRAN NJ
08075-1369
US

V. Phone/Fax

Practice location:
  • Phone: 215-707-1020
  • Fax:
Mailing address:
  • Phone: 609-947-3526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MISS COLLEEN MONTGOMERY
Title or Position: RESIDENCY COORDINATOR
Credential:
Phone: 215-707-1020