Provider Demographics
NPI:1699237602
Name:PHILADELPHIA DENTAL LASER & COSMETIC DENTISTRY LLC
Entity type:Organization
Organization Name:PHILADELPHIA DENTAL LASER & COSMETIC DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:TARNOSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:610-888-3291
Mailing Address - Street 1:3016 TOWNSHIP LINE RD
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-1823
Mailing Address - Country:US
Mailing Address - Phone:610-888-3291
Mailing Address - Fax:484-454-3744
Practice Address - Street 1:3016 TOWNSHIP LINE RD
Practice Address - Street 2:
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-1823
Practice Address - Country:US
Practice Address - Phone:610-888-3291
Practice Address - Fax:484-454-3744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-01
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty