Individual
DR. PUSHPA N. DOMADIA
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
128 E ALLEGHENY AVE., PHILADELPHIA, PA 19134-2207
(215) 634-4647
(215) 634-4647
Mailing address
128 E ALLEGHENY AVE, PHILADELPHIA, PA 19134-2207
(215) 634-4647
(215) 634-4647
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DS021004-L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0990660
—
PA
01
—
DO/460384
PENNSYLVANIA BLUE SHIELD
PA
Enumeration date
10/19/2005
Last updated
07/08/2007
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