Provider Demographics
NPI:1811948086
Name:SOCIETY HILL DENTAL PRACTICE P.C.
Entity type:Organization
Organization Name:SOCIETY HILL DENTAL PRACTICE P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEANG
Authorized Official - Middle Name:
Authorized Official - Last Name:KONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-575-0550
Mailing Address - Street 1:1601 WALNUT ST
Mailing Address - Street 2:SUITE 1217
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-2944
Mailing Address - Country:US
Mailing Address - Phone:215-575-0550
Mailing Address - Fax:215-575-0554
Practice Address - Street 1:1829 JFK BLVD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-1701
Practice Address - Country:US
Practice Address - Phone:215-575-0550
Practice Address - Fax:215-575-0554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-13
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS017127L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty