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Organization
MAIN STREET DENTAL CENTER CITY PC
Active
Organization
MAIN STREET DENTAL CENTER CITY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD VICTOR EIDELSON DDS, FAGD (PRESIDENT DENTIST)
(215) 627-1995
Entity
Organization
Contact information
Practice address
1048 SOUTH ST, PHILADELPHIA, PA 19147-1935
(215) 627-1995
(215) 627-1999
Mailing address
1048 SOUTH ST, PHILADELPHIA, PA 19147-1935
(215) 627-1995
(215) 627-1999
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DS019673L
PA
Other
Enumeration date
05/29/2007
Last updated
04/22/2011
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