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General NPI Number Information
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NPI Number | 1700119187
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Entity Type | Organization
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Legal Business Name | JOHN WHYTOSEK D.M.D. P.C
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Dates
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Enumeration Date | 09/16/2009
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Last Update Date | 09/16/2009
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Provider Practice Location Address
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Address Line | 2004 SPROUL ROAD SUITE 304
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City | BROOMALL
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State | PA
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Zip | 19008
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Country | US
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Telephone | 610-353-8200
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Fax | 610-356-0900
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Provider Business Mailing Address
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Address Line | 2004 SPROUL ROAD SUITE 304
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City | BROOMALL
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State | PA
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Zip | 19008
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Country | US
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Telephone | 610-353-8200
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Fax | 610-356-0900
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. MARIANN SMITH
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Credential |
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Telephone | 610-353-8200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | DS030593L
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License Number State | PA
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