Organization · NPI-2

5th Street Dental Center INC

Dentist, General Practice · Philadelphia, PA

NPI number1801939012
StatusActive
Last updated in NPPESApr 8, 2008

Details

NPI
1801939012
Entity type
Organization (NPI-2)
Legal business name
5th Street Dental Center INC
Organization subpart
No
Enumeration date
Feb 15, 2007
Last updated
Apr 8, 2008

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
1223G0001X Dentist, General PracticeDS018692-LPAYes

Practice location

4646 North 5th St
Philadelphia, PA 19140

Phone 215-324-1950 · Fax 215-324-1950

Mailing address

4646 North 5th St
Philadelphia, PA 19140

Phone 215-324-1950 · Fax 215-324-1950

Authorized official

Sharon E Wilson
Owner
2153241950

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