Organization
PENNSYLVANIA DENTAL GROUP LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GEORGE E BOUDREAU DMD (DMD PRESIDENT)
(215) 387-0883
Entity
Organization
Contact information
Practice address
1740 SOUTH ST, SUITE 504, PHILA, PA 19146
(215) 545-6334
(215) 893-4675
Mailing address
1740 SOUTH ST, SUITE 504, PHILA, PA 19146
(215) 387-0883
(215) 387-9659
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DS035436
PA
122300000X
Dentist
DS18680L
PA
122300000X
Dentist
DS19260L
PA
Other
Enumeration date
01/30/2007
Last updated
08/22/2020
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