LOCUST STREET PERIODONTICS IMPLANT DENTISTRY L.L.C. NPI 1063536290

NPI Information

LOCUST STREET PERIODONTICS IMPLANT DENTISTRY L.L.C. is a periodontics dentist in Philadelphia, PA. The provider is that specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues. LOCUST STREET PERIODONTICS IMPLANT DENTISTRY L.L.C. NPI is 1063536290. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

1500 LOCUST ST.
SUITE 1408
PHILADELPHIA, PA
ZIP 19102-314
Phone: (215) 732-4450
Fax: (215) 735-9886

The provider's authorized official is Joseph Gian-grasso .
The authorized official title is Owner and has the following contact phone number (215) 732-4450.

The enumeration date for this NPI number is 3/16/2007 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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