MEDICARE: PRINCE OFOSU-MENSAH, DMD, PC.

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	122300000X	Dentist

General Provider Information

NPI Number	:	1457525214
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRINCE OFOSU-MENSAH, DMD, PC.

Provider Business Mailing Address
First Line	:	4216 LORING ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19136-3917
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1619 GRANT AVE
Second Line	:	SUITE 23
City	:	PHILADELPHIA
State	:	PA
Zip	:	19115-3167
Country	:	US
Telephone Number	:	215-673-4940
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PRINCE OFOSU-MENSAH
Credential	:	DMD
Telephone Number	:	215-673-4940

Provider Enumeration Date	:	04/14/2008
Last Update Date	:	04/14/2008

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