=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033278528
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NICE CARE DENTAL ASSOCIATES OF SOUTH PHILADELPHIA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/08/2006
-----------------------------------------------------
Last Update Date | 06/09/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1320 W RITNER ST 1ST FLOOR
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19148-3525
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-389-3876
-----------------------------------------------------
Fax | 215-389-1442
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1320 W RITNER ST 1ST FLOOR
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19148-3525
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-389-3876
-----------------------------------------------------
Fax | 215-389-1442
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | DR. HONG NI
-----------------------------------------------------
Credential | D.M.D
-----------------------------------------------------
Telephone | 215-389-3876
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | DS035434
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------