NPIMap

Organization Active NPI

Temple University of the Commonwealth System of Higher Education

Doing business as Temple University Kornberg School of Dentistry

  • Dental Clinic/Center
  • Philadelphia, PA
National Provider Identifier
1841268604
Registry record updated Sep 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
TEMPLE UNIVERSITY OF THE COMMONWEALTH SYSTEM OF HIGHER EDUCATION
Doing business as
Temple University Kornberg School of Dentistry
Practice address
3223 N Broad St
Philadelphia, PA 19140-5007
Phone
(215) 707-7756
Fax
(215) 707-5885
NPI assigned
Mar 9, 2006
Last updated
Sep 6, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
TEMPLE UNIVERSITYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 6, 2024

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

Authorized official

Name
Angelina Fagan
Title
Financial Supervisor / Manager
Phone
(215) 707-2828

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X NU Primary

Addresses

Primary practice location

3223 N Broad St
Philadelphia, PA 19140-5007

Mailing address

3223 N Broad St
Philadelphia, PA 19140-5007
Phone (215) 707-2912

Other identifiers 1

IdentifierTypeStateIssuer
1007780130612MedicaidPA

Other names 1

  • TEMPLE UNIVERSITY KORNBERG SCHOOL OF DENTISTRY Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040219000333 PA Part B Supplier - Clinic/Group Practice 2961314299 Receives reassigned benefits from 19 practitioners
This NPI is an additional NPI on the enrollment
Practice locations: Philadelphia, PA

National Provider Directory

National Provider Directory
Part of
Temple Rheumatology Ass

Practitioners & affiliated clinicians

Practitioners 41

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.

View all 41

NPI Registry JSON

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

{
    "created_epoch": "1141862400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725580800000",
    "number": "1841268604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3223 N BROAD ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191405007",
            "telephone_number": "215-707-2912",
            "fax_number": "215-707-5885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3223 N BROAD ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191405007",
            "telephone_number": "215-707-7756",
            "fax_number": "215-707-5885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TEMPLE UNIVERSITY OF THE COMMONWEALTH SYSTEM OF HIGHER EDUCATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TEMPLE UNIVERSITY",
        "enumeration_date": "2006-03-09",
        "last_updated": "2024-09-06",
        "certification_date": "2024-09-06",
        "status": "A",
        "authorized_official_last_name": "FAGAN",
        "authorized_official_first_name": "ANGELINA",
        "authorized_official_title_or_position": "FINANCIAL SUPERVISOR / MANAGER",
        "authorized_official_telephone_number": "215-707-2828"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007780130612",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TEMPLE UNIVERSITY KORNBERG SCHOOL OF DENTISTRY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Sep 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.