| Pediatric Dental Assoc Ltd | |
|
3509 N Broad St 6th Fl W Philadelphia PA 19140 | |
| (215) 707-6411 | |
| (215) 707-6417 |
| Full Name | Pediatric Dental Assoc Ltd |
|---|---|
| Speciality | Dentist |
| Location | 3509 N Broad St, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Michael S Rosenbaum (PARTNER) |
| Authorized Official Contact | 2187433700 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pediatric Dental Assoc Ltd 6404 Roosevelt Blvd Phila PA 19149 Ph: (215) 743-3700 | Pediatric Dental Assoc Ltd 3509 N Broad St 6th Fl W Philadelphia PA 19140 Ph: (215) 707-6411 |
| NPI Number | 1386708121 |
|---|---|
| Provider Enumeration Date | 12/19/2006 |
| Last Update Date | 05/30/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386708121 | NPI | - | NPPES |
| 0005297280003 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | DS025205L (Pennsylvania) | Primary |
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