MEDICARE: DAN DECEBAL DAVID 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	122300000X	Dentist	D008098	AZ
2	122300000X	Dentist	DS038607	PA

General Provider Information

NPI Number	:	1669782355
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAN DECEBAL DAVID D.M.D

Provider Business Mailing Address
First Line	:	2675 E CUMBERLAND ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19125-3727
Country	:	US
Telephone Number	:	215-426-7307
Fax Number	:

Provider Business Practice Location Address
First Line	:	2675 E CUMBERLAND ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19125-3727
Country	:	US
Telephone Number	:	215-426-7307
Fax Number	:

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

Provider Enumeration Date	:	10/14/2010
Last Update Date	:	01/15/2016

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