Provider Demographics
NPI:1114384799
Name:SPECIALTY DENTAL PARTNERS OF PHILADELPHIA PLLC
Entity Type:Organization
Organization Name:SPECIALTY DENTAL PARTNERS OF PHILADELPHIA PLLC
Other - Org Name:RICH ORTODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NATIONAL DIRECTOR OF RCM
Authorized Official - Prefix:
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:
Authorized Official - Last Name:LESSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-571-3471
Mailing Address - Street 1:136 4TH ST N STE 201
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-3889
Mailing Address - Country:US
Mailing Address - Phone:727-800-8026
Mailing Address - Fax:727-304-3164
Practice Address - Street 1:2300 COMPUTER RD STE L62
Practice Address - Street 2:
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-1739
Practice Address - Country:US
Practice Address - Phone:215-618-8798
Practice Address - Fax:215-383-0115
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPECIALTY DENTAL PARTNERS OF PHILADELPHIA PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-01-27
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty