Provider Demographics
NPI:1629166020
Name:SOCIETY HILL DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:SOCIETY HILL DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:J
Authorized Official - Last Name:BONOMO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:215-238-0800
Mailing Address - Street 1:21 S 5TH ST
Mailing Address - Street 2:SUITE 610
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-2515
Mailing Address - Country:US
Mailing Address - Phone:215-238-0800
Mailing Address - Fax:
Practice Address - Street 1:21 S 5TH ST
Practice Address - Street 2:SUITE 610
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-2515
Practice Address - Country:US
Practice Address - Phone:215-238-0800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS025793-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty