Provider Demographics
NPI:1790044535
Name:EXCEL ENDODONTICS OF PENNSYLVANIA, LLC
Entity Type:Organization
Organization Name:EXCEL ENDODONTICS OF PENNSYLVANIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ENDODONTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:VETTRAINO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:215-755-1001
Mailing Address - Street 1:2546 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19145-4638
Mailing Address - Country:US
Mailing Address - Phone:215-755-1001
Mailing Address - Fax:215-755-1406
Practice Address - Street 1:2546 S BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145-4638
Practice Address - Country:US
Practice Address - Phone:215-755-1001
Practice Address - Fax:215-755-1406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-14
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS037946261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental