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General NPI Number Information
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NPI Number | 1619186038
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Entity Type | Organization
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Legal Business Name | OSCAR GOREN DMD PC
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 09/12/2011
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Provider Practice Location Address
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Address Line | 2412 RHAWN ST
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City | PHILADELPHIA
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State | PA
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Zip | 19152-3324
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Country | US
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Telephone | 215-332-5259
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Fax |
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Provider Business Mailing Address
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Address Line | 2412 RHAWN ST
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City | PHILADELPHIA
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State | PA
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Zip | 19152-3324
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Country | US
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Telephone | 215-332-5259
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. OSCAR GOREN
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Credential | DMD
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Telephone | 215-332-5259
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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 19920 L
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License Number State | PA
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