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General NPI Number Information
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NPI Number | 1992713796
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Entity Type | Organization
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Legal Business Name | ANNA KORNBROT DMD PC
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Dates
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Enumeration Date | 08/04/2006
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Last Update Date | 03/20/2012
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Provider Practice Location Address
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Address Line | 1601 WALNUT STREET STE 902
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City | PHILA
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State | PA
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Zip | 19102
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Country | US
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Telephone | 215-563-6263
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Fax | 215-563-9898
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Provider Business Mailing Address
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Address Line | 1601 WALNUT STREET STE 902
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City | PHILA
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State | PA
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Zip | 19102
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Country | US
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Telephone | 215-563-6263
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Fax | 215-563-9898
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ANNA KORNBROT
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Credential | DMD
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Telephone | 215-563-6263
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DS021370L
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License Number State | PA
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