MEDICARE: ADELPHIA DENTAL MANAGEMENT

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

General Provider Information

NPI Number	:	1992182497
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADELPHIA DENTAL MANAGEMENT

Provider Business Mailing Address
First Line	:	1507 W PASSYUNK AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19145-3029
Country	:	US
Telephone Number	:	215-259-5655
Fax Number	:	267-553-4444

Provider Business Practice Location Address
First Line	:	1507 W PASSYUNK AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19145-3029
Country	:	US
Telephone Number	:	215-259-5655
Fax Number	:	267-553-4444

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	MICHAEL ALEXANDER
Credential	:
Telephone Number	:	215-259-5655

Provider Enumeration Date	:	05/04/2015
Last Update Date	:	05/04/2015

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