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General NPI Number Information
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NPI Number | 1568650166
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Entity Type | Individual
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Provider Name | PRINCE OFOSU-MENSAH DMD
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Gender | Male
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Dates
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Enumeration Date | 10/09/2007
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Last Update Date | 04/04/2016
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Provider Practice Location Address
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Address Line | 640 SNYDER AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19148-2419
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Country | US
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Telephone | 215-334-4900
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Fax | 215-334-9721
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Provider Business Mailing Address
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Address Line | 432 N 6TH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19123-4004
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Country | US
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Telephone | 215-925-2400
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Fax | 215-925-9162
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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 | DS037177
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License Number State | PA
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