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General NPI Number Information
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NPI Number | 1740616895
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Entity Type | Organization
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Legal Business Name | PERIODONTAL CONSULTANTS PC
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Dates
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Enumeration Date | 09/20/2013
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Last Update Date | 09/20/2013
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Provider Practice Location Address
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Address Line | 2546 S BROAD ST REAR
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City | PHILADELPHIA
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State | PA
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Zip | 19145-4638
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Country | US
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Telephone | 215-463-6677
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Fax |
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Provider Business Mailing Address
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Address Line | 2546 S BROAD ST REAR
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City | PHILADELPHIA
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State | PA
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Zip | 19145-4638
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | INSURANCE COORDINATOR
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Name | MRS. MELISSA REMENTER
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Credential |
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Telephone | 215-940-9001
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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 |
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License Number State |
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