Provider Demographics
NPI:1619368933
Name:WILLIAM D. MESTICHELLI D.D.S., P.C.
Entity Type:Organization
Organization Name:WILLIAM D. MESTICHELLI D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MESTICHELLI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:215-334-2000
Mailing Address - Street 1:1903 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19148-2216
Mailing Address - Country:US
Mailing Address - Phone:215-334-2000
Mailing Address - Fax:215-755-7333
Practice Address - Street 1:1903 S BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148-2216
Practice Address - Country:US
Practice Address - Phone:215-334-2000
Practice Address - Fax:215-755-7333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-09
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS022834L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty