NPIMap

Organization Active NPI

Pediatric Dental Assoc LTD

  • Dentist
  • Philadelphia, PA
National Provider Identifier
1457416356
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
100 E Lehigh Ave
Philadelphia, PA 19125
Phone
(215) 707-1030
Fax
(215) 707-0083
NPI assigned
Dec 22, 2006
Last updated
May 30, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
PEDIATRIC DENTAL ASSOCIATESAs 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, DMDNPI 1104810530
Title
Partner
Phone
(215) 743-3700

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DS025205L PA Primary

Addresses

Primary practice location

100 E Lehigh Ave
Philadelphia, PA 19125

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
0005299280001MedicaidPA

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.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1166745600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212105600000",
    "number": "1457416356",
    "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": "215-743-3706"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 E LEHIGH AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19125",
            "telephone_number": "215-707-1030",
            "fax_number": "215-707-0083"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC DENTAL ASSOC LTD",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PEDIATRIC DENTAL ASSOCIATES",
        "enumeration_date": "2006-12-22",
        "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": "215-743-3700",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "PA",
            "license": "DS025205L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0005299280001",
            "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.