Healthcare Provider Details

I. General information

NPI: 1871793141
Provider Name (Legal Business Name): PETER A. CILENTO, D.M.D. AND MARYAM SHOLEHVAR, D.M.D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 07/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 S CEDAR CREST BLVD SUITE 100
ALLENTOWN PA
18103-7901
US

IV. Provider business mailing address

1104 S CEDAR CREST BLVD SUITE 100
ALLENTOWN PA
18103-7901
US

V. Phone/Fax

Practice location:
  • Phone: 610-437-4486
  • Fax: 610-437-5071
Mailing address:
  • Phone: 610-437-4486
  • Fax: 610-437-5071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: LINDA LEE ANTHONY
Title or Position: ADMINISTRATIVE ASSISTANT
Credential:
Phone: 610-437-4486