Organization
UNITED DENTAL USA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JARED AYES (OPERATIONS MANAGER)
(267) 774-5629
Entity
Organization
Contact information
Practice address
1501 E WADSWORTH AVE, PHILADELPHIA, PA 19150-1605
(267) 774-5629
(267) 774-5639
Mailing address
1501 E WADSWORTH AVE, PHILADELPHIA, PA 19150-1605
(267) 774-5629
(267) 774-5639
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DS019126L
PA
1223G0001X
General Practice Dentistry
DS019126L
PA
Other
Enumeration date
11/11/2015
Last updated
11/11/2015
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