Provider Demographics
NPI:1922172071
Name:PIDLAON, LEMUEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEMUEL
Middle Name:
Last Name:PIDLAON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1936 COTTMAN AVE
Mailing Address - Street 2:2ND FL
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-3800
Mailing Address - Country:US
Mailing Address - Phone:215-728-0777
Mailing Address - Fax:267-672-1212
Practice Address - Street 1:1936 COTTMAN AVE
Practice Address - Street 2:2ND FL
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-3800
Practice Address - Country:US
Practice Address - Phone:215-549-6868
Practice Address - Fax:215-549-6860
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0355591223G0001X
PADS035559L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100951638Medicaid