Individual
DR. MARIELISA OTERO HENAO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
3951 LANCASTER AVE, PHILADELPHIA, PA 19104-4636
(413) 657-4028
Mailing address
300 ALEXANDER CT APT 412, PHILADELPHIA, PA 19103-1159
(413) 657-4028
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DS044202
PA
Other
Enumeration date
12/07/2023
Last updated
01/04/2024
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