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General NPI Number Information
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NPI Number | 1639558950
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Entity Type | Organization
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Legal Business Name | PEDIATRIC DENTAL ASSOCIATES, LTD
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Dates
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Enumeration Date | 05/19/2015
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Last Update Date | 05/19/2015
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Provider Practice Location Address
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Address Line | 2301 E ALLEGHENY AVE SUITE 201
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City | PHILADELPHIA
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State | PA
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Zip | 19134-4427
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Country | US
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Telephone | 215-707-1030
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Fax | 215-707-0083
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Provider Business Mailing Address
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Address Line | 2301 E ALLEGHENY AVE SUITE 201
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City | PHILADELPHIA
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State | PA
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Zip | 19134-4427
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Country | US
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Telephone | 215-707-1030
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Fax | 215-707-0083
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK S GOLDSTEIN
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Credential | DDS
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Telephone | 215-707-1016
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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 | DS036846
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License Number State | PA
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