=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922172071
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LEMUEL PIDLAON DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/20/2006
-----------------------------------------------------
Last Update Date | 12/07/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1936 COTTMAN AVE 2ND FL
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19111-3800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-549-6868
-----------------------------------------------------
Fax | 215-549-6860
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1936 COTTMAN AVE 2ND FL
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19111-3800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-728-0777
-----------------------------------------------------
Fax | 267-672-1212
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | DS035559
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | DS035559L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------