MEDICARE: PARVEENSULTANADMDPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DS038274	PA

General Provider Information

NPI Number	:	1275832743
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARVEENSULTANADMDPC

Provider Business Mailing Address
First Line	:	275 S BRYN MAWR AVE
Second Line	:	APT A19
City	:	BRYN MAWR
State	:	PA
Zip	:	19010-4202
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2919 N 22ND ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19132-1505
Country	:	US
Telephone Number	:	518-534-2855
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	PARVEEN SULTANA
Credential	:	DMD
Telephone Number	:	518-534-2855

Provider Enumeration Date	:	03/22/2011
Last Update Date	:	03/22/2011

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