Healthcare Provider Details

I. General information

NPI: 1881707438
Provider Name (Legal Business Name): PROSTHODONTICS LIMITED, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8021 CASTOR AVE SUITE B
PHILADELPHIA PA
19152-2733
US

IV. Provider business mailing address

8021 CASTOR AVE SUITE B
PHILADELPHIA PA
19152-2733
US

V. Phone/Fax

Practice location:
  • Phone: 215-728-1696
  • Fax: 215-745-8811
Mailing address:
  • Phone: 215-728-1696
  • Fax: 215-745-8811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDS020416L
License Number StatePA

VIII. Authorized Official

Name: DR. JOSEPH B BREITMAN
Title or Position: OWNER
Credential: D.M.D
Phone: 215-728-1696