| City Dental Llc | |
|
1100 Washington Ave 2nd Floor Philadelphia PA 19147 | |
| (215) 462-4877 | |
| (215) 462-4871 |
| Full Name | City Dental Llc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1100 Washington Ave 2nd Floor, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Jae Chae (OWNER) |
| Authorized Official Contact | 2154624877 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| City Dental Llc 1100 Washington Ave 2nd Floor Philadelphia PA 19147 Ph: (215) 704-0056 | City Dental Llc 1100 Washington Ave 2nd Floor Philadelphia PA 19147 Ph: (215) 462-4877 |
| NPI Number | 1972072908 |
|---|---|
| Provider Enumeration Date | 11/20/2018 |
| Last Update Date | 11/20/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972072908 | NPI | - | NPPES |
| 102705580 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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