Organization
ALLEGRO DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GRACE LEE (DENTIST)
(917) 407-8034
Entity
Organization
Contact information
Practice address
100 E ALLEGHENY AVE, PHILADELPHIA, PA 19134-2207
(215) 290-8230
Mailing address
100 E ALLEGHENY AVE, PHILADELPHIA, PA 19134-2207
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DS039072
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1027531850002
—
PA
Enumeration date
08/05/2014
Last updated
08/05/2014
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