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General NPI Number Information
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NPI Number | 1841362217
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Entity Type | Organization
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Legal Business Name | AMAZING DENTAL CARE, P.C.
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8415 BUSTLETON AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19152-1901
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Country | US
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Telephone | 215-725-4564
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Fax | 215-725-4565
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Provider Business Mailing Address
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Address Line | 8415 BUSTLETON AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19152-1901
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Country | US
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Telephone | 215-725-4564
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Fax | 215-725-4565
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Authorized Official
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Title or Position | DENTIST
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Name | DR. STEPHEN WILFRED
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Credential | D.D.S.
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Telephone | 215-725-4564
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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 | DS-031430-L
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License Number State | PA
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