Organization
PEDIATRIC DENTAL ASSOCIATES, LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK S GOLDSTEIN DDS (PRESIDENT)
(215) 707-1016
Entity
Organization
Contact information
Practice address
2301 E ALLEGHENY AVE, SUITE 201, PHILADELPHIA, PA 19134-4427
(215) 707-1030
(215) 707-0083
Mailing address
2301 E ALLEGHENY AVE, SUITE 201, PHILADELPHIA, PA 19134-4427
(215) 707-1030
(215) 707-0083
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DS036846
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0005299280006
—
PA
Enumeration date
05/19/2015
Last updated
05/19/2015
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