Healthcare Provider Details

I. General information

NPI: 1972013167
Provider Name (Legal Business Name): ADA YODER PHDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2017
Last Update Date: 10/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3156 KENSINGTON AVE
PHILADELPHIA PA
19134-2400
US

IV. Provider business mailing address

3156 KENSINGTON AVE
PHILADELPHIA PA
19134-2400
US

V. Phone/Fax

Practice location:
  • Phone: 215-302-3156
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberPHDH000930
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: