Provider Demographics
NPI:1750360442
Name:GOREN, OSCAR (DMD)
Entity type:Individual
Prefix:DR
First Name:OSCAR
Middle Name:
Last Name:GOREN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:OSCAR
Other - Middle Name:
Other - Last Name:GOREN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD, PC
Mailing Address - Street 1:2412 RHAWN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-3324
Mailing Address - Country:US
Mailing Address - Phone:215-332-5259
Mailing Address - Fax:
Practice Address - Street 1:2412 RHAWN ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-3324
Practice Address - Country:US
Practice Address - Phone:215-332-5259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-19920-L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist