# PEDIATRIC DENTAL ASSOC LTD

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** PEDIATRIC DENTAL ASSOCIATES LTD
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1386708121
- **Legal business name:** PEDIATRIC DENTAL ASSOCIATES LTD
- **Authorized official:** MICHAEL S ROSENBAUM DMD (PARTNER)
- **Authorized official phone:** (218) 743-3700

## Contact information

- **Practice address:** 3509 N BROAD ST, 6TH FL W, PHILADELPHIA, PA 19140
- **Practice address phone:** (215) 707-6411
- **Practice address fax:** (215) 707-6417
- **Mailing address:** 6404 ROOSEVELT BLVD, PHILA, PA 19149
- **Mailing address phone:** (215) 743-3700
- **Mailing address fax:** (215) 743-3715

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | DS025205L | PA | Yes |

## Other

- **Enumeration date:** 12/19/2006
- **Last updated:** 05/30/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0005297280003 | — | PA |