# TEMPLE UNIVERSITY KORNBERG SCHOOL OF DENTISTRY COMMUNITY DENTAL CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** TEMPLE UNIVERSITY KORNBERG SCHOOL OF DENTISTRY
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1649566738
- **Legal business name:** TEMPLE UNIVERSITY KORNBERG SCHOOL OF DENTISTRY
- **Authorized official:** MS. DEBORAH RICKS (FINANCIAL MANAGER)
- **Authorized official phone:** (215) 707-7756

## Contact information

- **Practice address:** 3223 N. BROAD ST., PHILADELPHIA, PA 19140-5007
- **Practice address phone:** (215) 707-7756
- **Practice address fax:** (215) 707-5885
- **Mailing address:** 3223 N BROAD ST, PHILADELPHIA, PA 19140-5007
- **Mailing address phone:** (215) 707-7756
- **Mailing address fax:** (215) 707-5885

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | DS018795L | PA | Yes |

## Other

- **Enumeration date:** 06/27/2011
- **Last updated:** 06/27/2011