Healthcare Provider Details

I. General information

NPI: 1023470895
Provider Name (Legal Business Name): DENTAL IMPLANT SOLUTIONS OF GREATER PHILADELPHIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 03/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 EASTON RD
ABINGTON PA
19001-3128
US

IV. Provider business mailing address

1260 EASTON RD
ABINGTON PA
19001-3128
US

V. Phone/Fax

Practice location:
  • Phone: 215-695-6666
  • Fax: 215-884-9085
Mailing address:
  • Phone: 215-695-6666
  • Fax: 215-884-9085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS020755L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDS026216L
License Number StatePA

VIII. Authorized Official

Name: DR. I. JAY FREEDMAN
Title or Position: OWNER
Credential: DDS
Phone: 215-695-6666