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General NPI Number Information
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NPI Number | 1043696875
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Entity Type | Organization
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Legal Business Name | ADELPHIA DENTAL MANAGEMENT LLC
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Dates
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Enumeration Date | 08/04/2015
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Last Update Date | 08/20/2015
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Provider Practice Location Address
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Address Line | 10050 ROOSEVELT BLVD
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City | PHILADELPHIA
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State | PA
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Zip | 19116-3965
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Country | US
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Telephone | 215-277-2177
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Fax | 610-340-9060
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Provider Business Mailing Address
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Address Line | 10050 ROOSEVELT BLVD
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City | PHILADELPHIA
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State | PA
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Zip | 19116-3965
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Country | US
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Telephone | 215-277-2177
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Fax | 610-340-9060
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Authorized Official
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Title or Position | CONSULTANT
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Name | DR. DAVID WILLIAMS
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Credential |
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Telephone | 610-619-0061
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 1223G0001X
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 122300000X
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License Number State | PA
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