# THOMAS JEFFERSON UNIVERSITY HOSPITAL

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033520424
- **Authorized official:** DR. ROBERT DIECIDUE D.M.D., MD (CHAIR OF THE DEPT. OF ORAL SURGEON)
- **Authorized official phone:** (215) 955-6215

## Contact information

- **Practice address:** 909 WALNUT ST, PHILADELPHIA, PA 19107-5211
- **Practice address phone:** (215) 955-6215
- **Mailing address:** 5 STRATFORD DR, RANDOLPH, NJ 07869-2036

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 05/19/2014
- **Last updated:** 05/19/2014