Individual
DR. MICHAEL EARL DOCKTOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1522 LOCUST STREET, 3RD FLOOR, PHILADELPHIA, PA 19102
(215) 545-3744
(215) 545-3276
Mailing address
1522 LOCUST STREET, 3RD FLOOR, PHILADELPHIA, PA 19102
(215) 545-3744
(215) 545-3276
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DS017410L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
17410
DELTA DENTAL INS CO
—
01
—
177109
UNITED CONCORDIA INS CO
—
Enumeration date
11/14/2006
Last updated
07/08/2007
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