Individual
NIPUL TANNA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
240 S. 40TH STREET, PHILADELPHIA, PA 19104
(215) 898-8965
(215) 898-1687
Mailing address
240 S. 40TH STREET, PHILADELPHIA, PA 19104
(215) 898-8965
(215) 898-1687
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
DS027460L
PA
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
DS027460L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103552566
—
PA
Enumeration date
05/14/2007
Last updated
09/22/2022
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