Individual
DR. IRA LISS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
2001 LONGSHORE AVE, PHILADELPHIA, PA 19149-1816
(215) 331-6399
Mailing address
2001 LONGSHORE AVE, PHILADELPHIA, PA 19149-1816
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
027068
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0011857600002
—
PA
Enumeration date
01/09/2007
Last updated
07/08/2007
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