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General NPI Number Information
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NPI Number | 1912398272
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Entity Type | Organization
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Legal Business Name | DENTAL SPECIALIST OF PHILADELPHIA PC
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Dates
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Enumeration Date | 02/09/2015
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Last Update Date | 02/09/2015
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Provider Practice Location Address
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Address Line | 10501 ACADEMY RD STE C
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City | PHILADELPHIA
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State | PA
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Zip | 19114-1137
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Country | US
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Telephone | 215-237-1544
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Fax |
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Provider Business Mailing Address
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Address Line | 10501 ACADEMY RD STE C
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City | PHILADELPHIA
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State | PA
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Zip | 19114-1137
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Country | US
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Telephone | 215-237-1544
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MR. JATIN MOVALIA
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Credential |
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Telephone | 215-237-1544
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | DS029728L
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License Number State | PA
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