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428 Pennsylvania Ave Fort Washington PA 19034-3413 | |
| (215) 643-0300 | |
| (215) 643-0333 |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 428 Pennsylvania Ave, Fort Washington, Pennsylvania |
| Authorized Official Name and Position | Aeri (katie) Baek (OFFICE MANAGER) |
| Authorized Official Contact | 2156430300 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
428 Pennsylvania Ave Fort Washington PA 19034-3413 Ph: (215) 643-0300 | 428 Pennsylvania Ave Fort Washington PA 19034-3413 Ph: (215) 643-0300 |
| NPI Number | 1144619180 |
|---|---|
| Provider Enumeration Date | 01/14/2015 |
| Last Update Date | 01/14/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144619180 | NPI | - | NPPES |
| 101930230 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | DS037069 (Pennsylvania) | Primary |
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