Individual provider · NPI-1

Lee R Carrasco, MD DDS

Oral & Maxillofacial Surgery · Philadelphia, PA

NPI number1013946540
StatusActive
Last updated in NPPESApr 10, 2013

Details

NPI
1013946540
Entity type
Individual (NPI-1)
Name
Lee R Carrasco
Credential
MD DDS
Sex
Male
Sole proprietor
No
Enumeration date
Jun 30, 2006
Last updated
Apr 10, 2013

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
204E00000X Oral & Maxillofacial SurgeryMD418924PAYes
204E00000X Oral & Maxillofacial SurgeryDS031585LPA

Practice location

3400 Spruce Street
5 White Building
Philadelphia, PA 19104

Phone 215-662-3580

Mailing address

3400 Spruce Street
5 White Building
Philadelphia, PA 19104

Phone 215-662-3580

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