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General NPI Number Information
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NPI Number | 1336293174
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Entity Type | Individual
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Provider Name | TEJJY THOMAS DMD
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Gender | Male
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 04/20/2012
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Provider Practice Location Address
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Address Line | 220 S 16TH ST SUITE 900
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City | PHILADELPHIA
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State | PA
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Zip | 19102-3322
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Country | US
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Telephone | 215-545-2600
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Fax |
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Provider Business Mailing Address
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Address Line | 1801 BUTTONWOOD ST SUITE 1507
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City | PHILADELPHIA
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State | PA
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Zip | 19130-3945
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Country | US
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Telephone | 215-805-2333
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 036917
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DS036917
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License Number State | PA
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