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General NPI Number Information
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NPI Number | 1730268079
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Entity Type | Organization
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Legal Business Name | CHILDREN'S SURGICAL ASSOCIATES LTD
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 03/05/2025
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Provider Practice Location Address
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Address Line | 3401 CIVIC CENTER BLVD
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City | PHILADELPHIA
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State | PA
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Zip | 19104-4319
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Country | US
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Telephone | 215-590-1000
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Fax | 215-590-2496
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Provider Business Mailing Address
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Address Line | 3401 CIVIC CENTER BLVD
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City | PHILADELPHIA
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State | PA
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Zip | 19104-4319
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Country | US
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Telephone | 215-590-1000
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Fax | 267-425-9552
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | LINDA FLOCCO
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Credential |
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Telephone | 215-590-2700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number |
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License Number State |
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