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General NPI Number Information
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NPI Number | 1235448747
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Entity Type | Organization
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Legal Business Name | DENTALUX, LLC
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Dates
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Enumeration Date | 09/30/2010
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Last Update Date | 12/07/2010
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Provider Practice Location Address
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Address Line | 1308 COTTMAN AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19111-3606
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Country | US
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Telephone | 215-745-5100
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Fax | 215-745-7298
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Provider Business Mailing Address
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Address Line | 1308 COTTMAN AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19111-3606
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Country | US
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Telephone | 215-745-5100
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Fax |
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Authorized Official
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Title or Position | OWNER/ DENTIST
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Name | DR. JENNIFER DONSKOY
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Credential | DDS
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Telephone | 215-745-5100
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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 | DS036923
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License Number State | PA
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