Organization
PROVIDENCE DENTAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HADI GHAZZOULI DMD (OWNER)
(484) 902-8156
Entity
Organization
Contact information
Practice address
241 PLAZA DR STE 3, COLLEGEVILLE, PA 19426-4921
(484) 902-8156
Mailing address
241 PLAZA DR STE 3, COLLEGEVILLE, PA 19426-4921
(484) 902-8156
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
08/12/2019
Last updated
08/12/2019
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