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General NPI Number Information
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NPI Number | 1821519752
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Entity Type | Organization
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Legal Business Name | JOHN A TAKACS DMD
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Dates
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Enumeration Date | 06/30/2017
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Last Update Date | 06/30/2017
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Provider Practice Location Address
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Address Line | 1707W PASSYUNK AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19145
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Country | US
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Telephone | 215-271-7259
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Fax |
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Provider Business Mailing Address
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Address Line | 333 QUEEN ST
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City | PHILADELPHIA
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State | PA
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Zip | 19147-3220
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Country | US
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Telephone | 215-287-9871
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. JOHN ALEXANDER TAKACS
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Credential | DMD
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Telephone | 215-271-7259
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DS039780
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License Number State | PA
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