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General NPI Number Information
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NPI Number | 1356714448
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Entity Type | Organization
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Legal Business Name | UNITED DENTAL USA LLC
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Dates
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Enumeration Date | 11/11/2015
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Last Update Date | 11/11/2015
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Provider Practice Location Address
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Address Line | 1501 E WADSWORTH AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19150-1605
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Country | US
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Telephone | 267-774-5629
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Fax | 267-774-5639
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Provider Business Mailing Address
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Address Line | 1501 E WADSWORTH AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19150-1605
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Country | US
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Telephone | 267-774-5629
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Fax | 267-774-5639
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | JARED AYES
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Credential |
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Telephone | 267-774-5629
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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 | DS019126L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DS019126L
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License Number State | PA
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