Individual
JITU ROSE THOMAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1627 EMERSON ST, PHILADELPHIA, PA 19152-2243
(215) 203-4293
Mailing address
1627 EMERSON ST, PHILADELPHIA, PA 19152-2243
(215) 203-4293
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DS044177
PA
390200000X
Student in an Organized Health Care Education/Training Program
—
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Other
Enumeration date
04/10/2023
Last updated
06/27/2023
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