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General NPI Number Information
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NPI Number | 1174902530
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Entity Type | Organization
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Legal Business Name | TEMPLE UNIVERSITY KORNBERG SCHOOL OF DENTISYRY
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Dates
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Enumeration Date | 05/19/2015
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Last Update Date | 05/19/2015
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Provider Practice Location Address
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Address Line | 3223 N BROAD ST
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City | PHILADELPHIA
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State | PA
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Zip | 19140-5007
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Country | US
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Telephone | 215-707-2895
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Fax |
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Provider Business Mailing Address
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Address Line | 505 S 10TH ST UNIT J
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City | PHILADELPHIA
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State | PA
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Zip | 19147-1252
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Country | US
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Telephone | 215-629-9755
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Fax |
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Authorized Official
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Title or Position | CLINIC LEADER
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Name | DR. JOHN FRIEL
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Credential | DDS
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Telephone | 215-499-5770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DS016011L
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License Number State | PA
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