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General NPI Number Information
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NPI Number | 1770110272
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Entity Type | Organization
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Legal Business Name | PHILADELPHIA DENTAL COSMETICS
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Dates
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Enumeration Date | 03/25/2020
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Last Update Date | 03/25/2020
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Provider Practice Location Address
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Address Line | 1601 WALNUT ST SUITE 822
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City | PHILADELPHIA
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State | PA
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Zip | 19102
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Country | US
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Telephone | 215-557-7979
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Fax | 215-557-7930
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Provider Business Mailing Address
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Address Line | 1601 WALNUT ST SUITE 822
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City | PHILADELPHIA
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State | PA
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Zip | 19102
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Country | US
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Telephone | 215-557-7979
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Fax | 215-557-7930
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Authorized Official
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Title or Position | OWNER (SELF)
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Name | JAY J LIU
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Credential | DMD, FICOI
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Telephone | 267-250-8082
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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