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General NPI Number Information
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NPI Number | 1649314154
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Entity Type | Individual
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Provider Name | BRYAN E KENTNER D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 02/16/2007
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Last Update Date | 02/27/2013
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Provider Practice Location Address
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Address Line | 4220 COTTMAN AVE GROUND FLOOR
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City | PHILADELPHIA
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State | PA
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Zip | 19135-1105
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Country | US
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Telephone | 215-253-3668
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Fax |
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Provider Business Mailing Address
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Address Line | 11773 DIMARCO DR
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City | PHILADELPHIA
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State | PA
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Zip | 19154-3716
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Country | US
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Telephone | 215-696-3674
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | SC-004823-L
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License Number State | PA
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