Provider Demographics
NPI:1174902530
Name:TEMPLE UNIVERSITY KORNBERG SCHOOL OF DENTISYRY
Entity type:Organization
Organization Name:TEMPLE UNIVERSITY KORNBERG SCHOOL OF DENTISYRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC LEADER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:215-499-5770
Mailing Address - Street 1:505 S 10TH ST
Mailing Address - Street 2:UNIT J
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-1252
Mailing Address - Country:US
Mailing Address - Phone:215-629-9755
Mailing Address - Fax:
Practice Address - Street 1:3223 N BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-5007
Practice Address - Country:US
Practice Address - Phone:215-707-2895
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-19
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS016011L261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental