MEDICARE: JAMES DVORCHAK DDS 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	1223G0001X	General Practice Dentistry	DS022504L	PA

General Provider Information

NPI Number	:	1467500660
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMES DVORCHAK DDS PC

Provider Business Mailing Address
First Line	:	1614 E UPSAL ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19150-1426
Country	:	US
Telephone Number	:	215-276-9090
Fax Number	:	215-276-8105

Provider Business Practice Location Address
First Line	:	1614 E UPSAL ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19150-1426
Country	:	US
Telephone Number	:	215-276-9090
Fax Number	:	215-276-8105

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JAMES DAVID DVORCHAK
Credential	:	DDS
Telephone Number	:	215-276-9090

Provider Enumeration Date	:	01/06/2007
Last Update Date	:	08/22/2020

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