Individual
JORGE E NIETO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
R.D.H., D.M.D.
Contact information
Practice address
176 W CHEW AVE, PHILADELPHIA, PA 19120-2460
(215) 924-4677
Mailing address
176 W CHEW AVE, PHILADELPHIA, PA 19120-2460
(215) 924-4677
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DS-028100-L
PA
Other
Enumeration date
12/27/2006
Last updated
07/08/2007
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