Organization
RICHARD C SQUILLARO D.D.S., PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD CARMEN SQUILLARO D.D.S. (PRESIDENT)
(215) 463-6677
Entity
Organization
Contact information
Practice address
2546 S BROAD ST, PHILADELPHIA, PA 19145-4638
(215) 463-6677
(215) 463-1077
Mailing address
1512 TEMPLE DR, MAPLE GLEN, PA 19002-3312
(215) 628-8627
(215) 628-8937
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
DS017459L
PA
Other
Enumeration date
04/11/2007
Last updated
05/14/2013
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