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Organization
GALLERY MALL DENTAL PC
Active
Organization
GALLERY MALL DENTAL PC
Active
Parent organization
GALLERY MALL DENTAL
Organization subpart
Yes
Provider details
NPI number
Legal business name
GALLERY MALL DENTAL
Authorized official
PROLAY KUMAR PAUL D.D.S (PARTNER)
(215) 627-4290
Entity
Organization
Contact information
Practice address
901 MARKET ST, SPACE 3220 GALLERY MALL ONE, PHILADELPHIA, PA 19107
(215) 627-4290
(215) 627-4293
Mailing address
901 MARKET ST, SPACE 3220, PHILADELPHIA, PA 19107
(215) 627-4290
(215) 627-4293
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DS037088
PA
122300000X
Dentist
Primary
DS037098
PA
1223G0001X
General Practice Dentistry
—
NULL
1223G0001X
General Practice Dentistry
—
—
Other
Enumeration date
11/24/2008
Last updated
12/18/2009
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