Individual
DR. KEISUKE WADA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
3401 MARKET STREET, SUITE 110, PHILADELPHIA, PA 19104
(215) 573-8400
Mailing address
150 E WYNNEWOOD RD, #2A, WYNNEWOOD, PA 19096
(610) 649-0570
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
DS039376
PA
Other
Enumeration date
11/07/2012
Last updated
11/07/2012
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