MEDICARE: DR. PAMELA GAYLE DORAY D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DS024070L	PA

General Provider Information

NPI Number	:	1235282229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAMELA GAYLE DORAY D.M.D.

Provider Business Mailing Address
First Line	:	1528 WALNUT ST
Second Line	:	SUITE 1800
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-3604
Country	:	US
Telephone Number	:	215-772-3100
Fax Number	:	215-772-1125

Provider Business Practice Location Address
First Line	:	1528 WALNUT ST
Second Line	:	SUITE 1800
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-3604
Country	:	US
Telephone Number	:	215-772-3100
Fax Number	:	215-772-1125

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/21/2007
Last Update Date	:	07/08/2007

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