SARA SUPRIYATNO

PHILADELPHIA, PA
NPI1225775778
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy390200000X Student in an Organized Health Care Education/Training Program
Additional Taxonomies1223G0001X Dentist, General Practice
(Licence: PA  DS043687)
Enumeration Date2022-05-17
Last Update Date2024-01-09
Business Address
SARA SUPRIYATNO DDS
909 WALNUT ST RM 300
PHILADELPHIA, PA 19107-5211
Phone number: 215-503-7118
Mailing Address
SARA SUPRIYATNO DDS
909 WALNUT ST RM 300
PHILADELPHIA, PA 19107-5211
Phone number: 215-503-7118