Provider Demographics
NPI:1649003930
Name:PA CHILDRENS DENTAL ANESTHESIA PC
Entity type:Organization
Organization Name:PA CHILDRENS DENTAL ANESTHESIA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZUCCARINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-870-6259
Mailing Address - Street 1:2301 E ALLEGHENY AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19134-4427
Mailing Address - Country:US
Mailing Address - Phone:215-870-6259
Mailing Address - Fax:267-639-6270
Practice Address - Street 1:2301 E ALLEGHENY AVE STE 120
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-4427
Practice Address - Country:US
Practice Address - Phone:215-870-6259
Practice Address - Fax:267-639-6270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty