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General NPI Number Information
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NPI Number | 1508275421
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Entity Type | Organization
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Legal Business Name | ALLEGRO DENTAL
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Dates
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Enumeration Date | 08/05/2014
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Last Update Date | 08/05/2014
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Provider Practice Location Address
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Address Line | 100 E ALLEGHENY AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19134-2207
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Country | US
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Telephone | 215-290-8230
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Fax |
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Provider Business Mailing Address
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Address Line | 100 E ALLEGHENY AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19134-2207
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | GRACE LEE
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Credential |
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Telephone | 917-407-8034
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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 | DS039072
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License Number State | PA
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