Organization
PEDIATRIC DENTAL ASSOC LTD
Active
Parent organization
PEDIATRIC DENTAL ASSOCIATES
Organization subpart
Yes
Provider details
NPI number
Legal business name
PEDIATRIC DENTAL ASSOCIATES
Authorized official
MICHAEL S ROSENBAUM DMD (PARTNER)
(215) 743-3700
Entity
Organization
Contact information
Practice address
100 E LEHIGH AVE, PHILADELPHIA, PA 19125
(215) 707-1030
(215) 707-0083
Mailing address
6404 ROOSEVELT BLVD, PHILA, PA 19149
(215) 743-3700
(215) 743-3706
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DS025205L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0005299280001
—
PA
Enumeration date
12/22/2006
Last updated
05/30/2008
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