NPIMap

Organization Active NPI

Pediatric Dental Assoc LTD

  • Dentist
  • Philadelphia, PA
National Provider Identifier
1386708121
Registry record updated May 30, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DS025205L Issued in PA
Legal business name
PEDIATRIC DENTAL ASSOC LTD
Practice address
3509 N Broad St
6TH FL W
Philadelphia, PA 19140
Phone
(215) 707-6411
Fax
(215) 707-6417
NPI assigned
Dec 19, 2006
Organization subpart
Yes
Parent organization
PEDIATRIC DENTAL ASSOCIATES LTDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 30, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Michael S Rosenbaum, DMD
Title
Partner
Phone
(218) 743-3700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X DS025205L PA Primary

Addresses

Primary practice location

3509 N Broad St
6TH FL W
Philadelphia, PA 19140

Mailing address

6404 Roosevelt Blvd
Phila, PA 19149
Phone (215) 743-3700

Other identifiers 1

IdentifierTypeStateIssuer
0005297280003MedicaidPA

National Provider Directory

National Provider Directory
Tax ID family
Pediatric Dental Assoc7 organizations share this tax ID, including this one
Part of
Pediatric Dental Assoc

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212105600000",
    "number": "1386708121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6404 ROOSEVELT BLVD",
            "city": "PHILA",
            "state": "PA",
            "postal_code": "19149",
            "telephone_number": "215-743-3700",
            "fax_number": "215-743-3715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3509 N BROAD ST",
            "address_2": "6TH FL W",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19140",
            "telephone_number": "215-707-6411",
            "fax_number": "215-707-6417"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC DENTAL ASSOC LTD",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PEDIATRIC DENTAL ASSOCIATES LTD",
        "enumeration_date": "2006-12-19",
        "last_updated": "2008-05-30",
        "status": "A",
        "authorized_official_last_name": "ROSENBAUM",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "218-743-3700",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "PA",
            "license": "DS025205L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0005297280003",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.