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General NPI Number Information
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NPI Number | 1316392566
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Entity Type | Organization
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Legal Business Name | ELKINS PARK DENTAL, INC.
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Dates
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Enumeration Date | 04/25/2016
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Last Update Date | 04/25/2016
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Provider Practice Location Address
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Address Line | 7900 OLD YORK RD SUITE 115A
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City | ELKINS PARK
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State | PA
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Zip | 19027-2318
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Country | US
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Telephone | 215-277-1807
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Fax |
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Provider Business Mailing Address
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Address Line | 8115 RIDGE AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19128-2901
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Country | US
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Telephone | 215-487-2347
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DAEUK MOON
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Credential |
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Telephone | 215-487-2347
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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 | DS037680
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License Number State | PA
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