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PENNSYLVANIA DENTAL GROUP LTD.
NPI 1114054962
Dentist - General Practice in Philadelphia, PA

Active since February 28, 2007
3550 MARKET ST, PHILADELPHIA, PA 19104(215) 387-0883(215) 387-9659 Get Directions Write a Review

NPPES record last updated: August 22, 2020. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Pennsylvania Dental Group Ltd. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PENNSYLVANIA DENTAL GROUP LTD. (NPI 1114054962) is a healthcare organization registered as a general practice in Philadelphia, Pennsylvania and active in the NPI registry since February 2007. The organization lists George E. Boudreau, President, as its authorized official.

NPPES Registry Identity

NPI1114054962
Entity TypeOrganization
Primary Taxonomy1223G0001X
Legal Business NamePENNSYLVANIA DENTAL GROUP LTD.
Location Address3550 MARKET STPhiladelphia, PA 19104-3329
Mailing Address3550 Market StPhiladelphia, PA 19104-3329 · (215) 387-0883 · Fax (215) 387-9659
Phone(215) 387-0883
Fax(215) 387-9659
Organization SubpartNo
Authorized OfficialGeorge E. BoudreauPresident · (215) 387-0883
Enumeration DateFebruary 28, 2007
Last NPPES UpdateAugust 22, 2020
✔ NPI 1114054962 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers
Taxonomy Code1223G0001X
License✔ Licensed in PA · DS18682L
Definition
A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.
3550 MARKET ST, Philadelphia, PA 19104
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. LEIGH ANN ROLA PA-C
Physician Assistant
3550 MARKET ST, 2ND FLOOR - PEDIATRIC DERMATOLOGY
PHILADELPHIA, PA 19104
Philadelphia County (215) 590-2169
DR. ELIZABETH ELLIOTT MD
Pediatrics
3550 MARKET ST, 5TH FLOOR
PHILADELPHIA, PA 19104
Philadelphia County (215) 590-3000
DR. LISA BIGGS MD
Pediatrics
3550 MARKET ST
PHILADELPHIA, PA 19104
Philadelphia County (215) 590-3000
ANGELA MARIE BURNS MSW
Social Worker
3550 MARKET ST
PHILADELPHIA, PA 19104
Philadelphia County (215) 590-2956
DR. TRUDE HAECKER MD
Pediatrics
3550 MARKET ST, 5TH FLOOR
PHILADELPHIA, PA 19104
Philadelphia County (215) 590-3000
KAITLIN GOY
Nurse Practitioner (Psychiatric/Mental Health)
3550 MARKET ST
PHILADELPHIA, PA 19104
Philadelphia County (215) 590-1000
CHRISTINE FORKE CPNP
Nurse Practitioner (Pediatrics)
3550 MARKET ST, CHOP/ADOLESCENT MED, 4TH FLOOR
PHILADELPHIA, PA 19104
Philadelphia County (215) 590-3537
MRS. DANIELLE FOY CRNP
Nurse Practitioner (Pediatrics)
3550 MARKET ST, 1ST & 2ND FLOORS
PHILADELPHIA, PA 19104
Philadelphia County (267) 426-7329

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Pennsylvania Dental Group Ltd.'s NPI number?

The NPI number for Pennsylvania Dental Group Ltd. is 1114054962. It was assigned to this organization in the NPPES registry on February 28, 2007.

Where is Pennsylvania Dental Group Ltd. located?

Pennsylvania Dental Group Ltd. is located at 3550 Market St, Philadelphia, PA 19104. The listed phone number is (215) 387-0883.

What is Pennsylvania Dental Group Ltd.'s specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

When was this NPI record last updated?

The NPPES record for Pennsylvania Dental Group Ltd. was last updated on August 22, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.