Provider Demographics
NPI:1750441408
Name:SHORE, PHILIP A (DMD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:A
Last Name:SHORE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 TREATY RD
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-5023
Mailing Address - Country:US
Mailing Address - Phone:610-449-2424
Mailing Address - Fax:
Practice Address - Street 1:200 TREATY RD
Practice Address - Street 2:
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-5023
Practice Address - Country:US
Practice Address - Phone:610-449-2424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS019091L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA159499OtherUNITED CONCORDIA