MEDICARE: OSCAR GOREN 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	1223G0001X	General Practice Dentistry	DS 19920 L	PA

General Provider Information

NPI Number	:	1619186038
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OSCAR GOREN DMD PC

Provider Business Mailing Address
First Line	:	2412 RHAWN ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19152-3324
Country	:	US
Telephone Number	:	215-332-5259
Fax Number	:

Provider Business Practice Location Address
First Line	:	2412 RHAWN ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19152-3324
Country	:	US
Telephone Number	:	215-332-5259
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. OSCAR GOREN
Credential	:	DMD
Telephone Number	:	215-332-5259

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	09/12/2011

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