Healthcare Provider Details

I. General information

NPI: 1275571218
Provider Name (Legal Business Name): JUDITH C TUCHMAN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 04/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3223 N BROAD ST KORNBERG SCHOOL OF DENTISTRY
PHILADELPHIA PA
19140-5007
US

IV. Provider business mailing address

3223 N BROAD ST KORNBERG SCHOOL OF DENTISTRY
PHILADELPHIA PA
19140-5007
US

V. Phone/Fax

Practice location:
  • Phone: 215-707-3288
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDI14418
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: