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Organization
PEDIATRIC DENTAL ASSOC LTD
Active
Organization
PEDIATRIC DENTAL ASSOC LTD
Active
Parent organization
PEDIATRIC DENTAL ASSOCIATES LTD
Organization subpart
Yes
Provider details
NPI number
Legal business name
PEDIATRIC DENTAL ASSOCIATES LTD
Authorized official
MICHAEL S ROSENBAUM DMD (PARTNER)
(218) 743-3700
Entity
Organization
Contact information
Practice address
3509 N BROAD ST, 6TH FL W, PHILADELPHIA, PA 19140
(215) 707-6411
(215) 707-6417
Mailing address
6404 ROOSEVELT BLVD, PHILA, PA 19149
(215) 743-3700
(215) 743-3715
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DS025205L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0005297280003
—
PA
Enumeration date
12/19/2006
Last updated
05/30/2008
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