Provider Demographics
NPI:1982267084
Name:FARM PARK PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:FARM PARK PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NGOZI
Authorized Official - Middle Name:
Authorized Official - Last Name:OKOH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:347-546-5215
Mailing Address - Street 1:4055 RIDGE AVE APT 8406
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1666
Mailing Address - Country:US
Mailing Address - Phone:347-546-5215
Mailing Address - Fax:
Practice Address - Street 1:502 W GERMANTOWN PIKE STE 100
Practice Address - Street 2:
Practice Address - City:EAST NORRITON
Practice Address - State:PA
Practice Address - Zip Code:19403-4232
Practice Address - Country:US
Practice Address - Phone:484-531-7620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-15
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty