Provider Demographics
NPI:1093015406
Name:COBBLESTONE KIDS PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:COBBLESTONE KIDS PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:LYNCH
Authorized Official - Suffix:IV
Authorized Official - Credentials:DMD
Authorized Official - Phone:215-913-3615
Mailing Address - Street 1:1101 WASHINGTON AVE
Mailing Address - Street 2:VILLA 1
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-3839
Mailing Address - Country:US
Mailing Address - Phone:215-913-3615
Mailing Address - Fax:
Practice Address - Street 1:1352 SOUTH ST
Practice Address - Street 2:C5
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-1858
Practice Address - Country:US
Practice Address - Phone:215-913-3615
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-01
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0367871223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty