Provider Demographics
NPI:1659490506
Name:PAPPAS-SFEDU, DIANE II
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:
Last Name:PAPPAS-SFEDU
Suffix:II
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 N 24TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-2535
Mailing Address - Country:US
Mailing Address - Phone:215-765-7745
Mailing Address - Fax:215-765-2550
Practice Address - Street 1:716 N 24TH ST
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19130-2535
Practice Address - Country:US
Practice Address - Phone:215-765-7745
Practice Address - Fax:215-765-2550
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS02565L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT71942Medicare UPIN