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Organization

THOMAS JEFFERSON UNIVERSITY HOSPITAL

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. ROBERT DIECIDUE D.M.D., MD (CHAIR OF THE DEPT. OF ORAL SURGEON)
(215) 955-6215
Entity
Organization

Contact information

Practice address
909 WALNUT ST, PHILADELPHIA, PA 19107-5211
(215) 955-6215
Mailing address
5 STRATFORD DR, RANDOLPH, NJ 07869-2036

Taxonomy

Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary

Other

Enumeration date
05/19/2014
Last updated
05/19/2014
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