Provider Demographics
NPI:1952449555
Name:JESO ADVANCED FAMILY DENTISTRY
Entity Type:Organization
Organization Name:JESO ADVANCED FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ESOCHI
Authorized Official - Middle Name:JOAN
Authorized Official - Last Name:IHEOMA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:215-755-6626
Mailing Address - Street 1:233 MCCLELLAN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19148-1918
Mailing Address - Country:US
Mailing Address - Phone:215-755-6626
Mailing Address - Fax:215-467-7151
Practice Address - Street 1:233 MCCLELLAN ST
Practice Address - Street 2:SUITE A
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148-1918
Practice Address - Country:US
Practice Address - Phone:215-755-6626
Practice Address - Fax:215-467-7151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-03
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0361471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty