Provider Demographics
NPI:1437728052
Name:TEMSTET, NESSIM
Entity Type:Individual
Prefix:
First Name:NESSIM
Middle Name:
Last Name:TEMSTET
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4105 SPRUCE ST APT D4
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4049
Mailing Address - Country:US
Mailing Address - Phone:646-673-7374
Mailing Address - Fax:
Practice Address - Street 1:200 WALNUT ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-3904
Practice Address - Country:US
Practice Address - Phone:215-923-2233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-18
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS043179122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist