Provider Demographics
NPI:1073646600
Name:ANTHONY M. PEDICINO,DDS.,PC.
Entity Type:Organization
Organization Name:ANTHONY M. PEDICINO,DDS.,PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:PEDICINO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:215-464-6663
Mailing Address - Street 1:1916 WELSH RD
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-4655
Mailing Address - Country:US
Mailing Address - Phone:215-464-6663
Mailing Address - Fax:215-464-4949
Practice Address - Street 1:1916 WELSH RD
Practice Address - Street 2:SUITE 1B
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-4655
Practice Address - Country:US
Practice Address - Phone:215-464-6663
Practice Address - Fax:215-464-4949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS023689-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty