Provider Demographics
NPI:1831642917
Name:DENTISTRY AT 1818 MARKET ST
Entity Type:Organization
Organization Name:DENTISTRY AT 1818 MARKET ST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:COADY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-567-2666
Mailing Address - Street 1:1818 MARKET ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-3638
Mailing Address - Country:US
Mailing Address - Phone:215-567-2666
Mailing Address - Fax:
Practice Address - Street 1:1818 MARKET ST
Practice Address - Street 2:SUITE 100
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-3638
Practice Address - Country:US
Practice Address - Phone:215-567-2666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS017950125K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes125K00000XDental ProvidersAdvanced Practice Dental TherapistGroup - Multi-Specialty