| Pennsylvania Center For Dental Implants And Periodontics, Llc | |
|
9880 Bustleton Ave Suite 211-212 Philadelphia PA 19115-2185 | |
| (215) 677-8686 | |
| (215) 677-7212 |
| Full Name | Pennsylvania Center For Dental Implants And Periodontics, Llc |
|---|---|
| Speciality | Dentist - Periodontics |
| Location | 9880 Bustleton Ave, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Tami Vishio (OFFICE MANAGER) |
| Authorized Official Contact | 2156778686 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pennsylvania Center For Dental Implants And Periodontics, Llc 9880 Bustleton Ave Suite 211-212 Philadelphia PA 19115-2185 Ph: (215) 677-8686 | Pennsylvania Center For Dental Implants And Periodontics, Llc 9880 Bustleton Ave Suite 211-212 Philadelphia PA 19115-2185 Ph: (215) 677-8686 |
| NPI Number | 1356700835 |
|---|---|
| Provider Enumeration Date | 02/12/2016 |
| Last Update Date | 02/12/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356700835 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0300X | Dentist - Periodontics | DS022257L (Pennsylvania) | Primary |
| 1223P0300X | Dentist - Periodontics | DS039673 (Pennsylvania) | Secondary |
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