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General NPI Number Information
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NPI Number | 1942868443
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Entity Type | Individual
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Provider Name | LENA MERCHO
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Gender | Female
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Dates
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Enumeration Date | 05/31/2019
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Last Update Date | 05/31/2019
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Provider Practice Location Address
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Address Line | 1507 W PASSYUNK AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19145-3029
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Country | US
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Telephone | 215-372-0060
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Fax |
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Provider Business Mailing Address
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Address Line | 1210 CHESTNUT ST UNIT 308
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City | PHILADELPHIA
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State | PA
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Zip | 19107-4855
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Country | US
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Telephone | 317-345-7809
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DS042159
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License Number State | PA
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