Healthcare Provider Details

I. General information

NPI: 1437459609
Provider Name (Legal Business Name): AMEN DHYLLON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2010
Last Update Date: 03/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E CITY LINE AVE SUITE G3
BALA CYNWYD PA
19004-1708
US

IV. Provider business mailing address

401 COMMERCE DR SUITE 108
FORT WASHINGTON PA
19034-2714
US

V. Phone/Fax

Practice location:
  • Phone: 610-660-9510
  • Fax: 610-660-9512
Mailing address:
  • Phone: 215-550-7186
  • Fax: 215-646-6369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS038245
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDS038245
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: