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General NPI Number Information
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NPI Number | 1063869030
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Entity Type | Organization
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Legal Business Name | 2020DENTISTRY
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Dates
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Enumeration Date | 05/19/2016
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Last Update Date | 05/19/2016
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Provider Practice Location Address
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Address Line | 1601 WALNUT ST SUITE 801
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City | PHILA
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State | PA
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Zip | 19102
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Country | US
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Telephone | 215-567-4949
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Fax | 215-567-0901
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Provider Business Mailing Address
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Address Line | 1601 WALNUT ST SUITE 801
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City | PHILADELPHIA
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State | PA
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Zip | 19102-2944
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Country | US
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Telephone | 215-567-4949
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Fax | 215-567-0901
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Authorized Official
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Title or Position | DENTIST
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Name | DR. PIERRE J MOURADIAN
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Credential | DMD
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Telephone | 215-567-4949
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 027190-L
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License Number State | PA
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