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General NPI Number Information
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NPI Number | 1396734935
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Entity Type | Individual
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Provider Name | STEPHEN F WILFRED D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 10/17/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 8415 BUSTLETON AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19152-1901
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Country | US
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Telephone | 215-725-4564
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Fax |
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Provider Business Mailing Address
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Address Line | 931 CHARTER CIR
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City | ELKINS PARK
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State | PA
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Zip | 19027-1614
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Country | US
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Telephone | 215-725-4564
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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 | DS-031430-L
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License Number State | PA
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