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Organization
PENNSYLVANIA DENTAL GROUP LTD.
Active
Organization
PENNSYLVANIA DENTAL GROUP LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GEORGE E. BOUDREAU (PRESIDENT)
(215) 387-0883
Entity
Organization
Contact information
Practice address
3550 MARKET ST, PHILADELPHIA, PA 19104-3329
(215) 387-0883
(215) 387-9659
Mailing address
3550 MARKET ST, PHILADELPHIA, PA 19104-3329
(215) 387-0883
(215) 387-9659
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DS18682L
PA
Other
Enumeration date
02/28/2007
Last updated
08/22/2020
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