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General NPI Number Information
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NPI Number | 1386978583
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Entity Type | Individual
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Provider Name | DR. ROSE OGADA WADENYA
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Gender | Female
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Dates
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Enumeration Date | 09/22/2009
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Last Update Date | 06/17/2013
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Provider Practice Location Address
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Address Line | 31 S. EAGLE ROAD SUITE 100
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City | HAVERTOWN
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State | PA
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Zip | 19083
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Country | US
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Telephone | 484-454-3568
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Fax |
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Provider Business Mailing Address
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Address Line | 31 S. EAGLE ROAD SUITE 100 EAGLE CREST PEDIATRIC DENTISTRY:
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City | HAVERTOWN
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State | PA
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Zip | 19083
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Country | US
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Telephone | 484-454-3568
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DS-030167-L
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License Number State | PA
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