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General NPI Number Information
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NPI Number | 1073646600
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Entity Type | Organization
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Legal Business Name | ANTHONY M. PEDICINO,DDS.,PC.
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 02/26/2008
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Provider Practice Location Address
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Address Line | 1916 WELSH RD SUITE 1B
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City | PHILADELPHIA
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State | PA
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Zip | 19115-4655
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Country | US
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Telephone | 215-464-6663
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Fax | 215-464-4949
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Provider Business Mailing Address
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Address Line | 1916 WELSH RD SUITE 1B
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City | PHILADELPHIA
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State | PA
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Zip | 19115-4655
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Country | US
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Telephone | 215-464-6663
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Fax | 215-464-4949
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANTHONY MICHAEL PEDICINO
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Credential | DDS.
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Telephone | 215-464-6663
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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 | DS023689-L
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License Number State | PA
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