1750119194 NPI number — THE CHILDREN'S TOOTH SPA II, P.C.

Table of content: (NPI 1750119194)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750119194 NPI number — THE CHILDREN'S TOOTH SPA II, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE CHILDREN'S TOOTH SPA II, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750119194
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/03/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
801 N 2ND ST FRNT 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19123-3090
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
267-353-4180
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1420 PROVIDENCE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHESTER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19013-5715
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-296-1010
Provider Business Practice Location Address Fax Number:
267-296-1012
Provider Enumeration Date:
07/25/2024

Additional Information

Authorized Official

Authorized Official Last Name:
PINERO
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
ROSE
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
267-353-4180

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com