# PROVIDENCE ENDODONTICS LLC

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

## Provider details

- **NPI number:** 1154548857
- **Authorized official:** DR. MEETU RALLI KOHLI D.M.D (PARTNER)
- **Authorized official phone:** (610) 676-9030

## Contact information

- **Practice address:** 450 CRESSON BLVD,, SUITE 303, OAKS, PA 19456-1218
- **Practice address phone:** (610) 676-9030
- **Practice address fax:** (610) 676-9032
- **Mailing address:** 450 CRESSON BLVD,, SUITE 303, P.O.BOX 1218, OAKS, PA 19456-1218
- **Mailing address phone:** (610) 676-9030
- **Mailing address fax:** (610) 676-9032

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223E0200X | Endodontics | — | PA | Yes |

## Other

- **Enumeration date:** 04/20/2007
- **Last updated:** 07/21/2022