Organization
GREATER PHILADELPHIA HEALTH ACTION INC.
Active
Other names
GPHA Southeast Dental Services
Organization subpart
No
Provider details
NPI number
Authorized official
D TINA SMITH (PROVIDER ENROLLMENT SPEC.)
(215) 925-2400
Entity
Organization
Contact information
Practice address
640 SNYDER AVENUE, PHILADELPHIA, PA 19148-2419
(215) 334-4900
(215) 334-9721
Mailing address
1401 S 31ST ST, 2ND FLOOR, PHILADELPHIA, PA 19146-3506
(215) 925-2400
(215) 925-9162
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
12/15/2006
Last updated
03/16/2017
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