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Organization
TEMPLE UNIVERSITY
Active
Organization
TEMPLE UNIVERSITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEISUKE WADA DMD (DIRECTOR CHAIR OF PERIODONTOLOGY)
(215) 707-7667
Entity
Organization
Contact information
Practice address
3223 N BROAD ST, DEPT OF PERIODONTOLOGY, PHILADELPHIA, PA 19140-5007
(215) 707-5774
Mailing address
3223 N BROAD ST, PHILADELPHIA, PA 19140-5007
(215) 707-5774
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
0401414955
VA
Other
Enumeration date
02/06/2017
Last updated
02/06/2017
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