Healthcare Provider Details

I. General information

NPI: 1417734187
Provider Name (Legal Business Name): SOCIETY HILL FAMILY DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2023
Last Update Date: 09/14/2023
Certification Date: 09/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 S INDEPENDENCE MALL E STE 610
PHILADELPHIA PA
19106-2509
US

IV. Provider business mailing address

111 S INDEPENDENCE MALL E STE 610
PHILADELPHIA PA
19106-2509
US

V. Phone/Fax

Practice location:
  • Phone: 215-238-0800
  • Fax:
Mailing address:
  • Phone: 215-238-0800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. CRYSTAL TUNO
Title or Position: MANAGER
Credential:
Phone: 610-286-0312