Healthcare Provider Details

I. General information

NPI: 1033611843
Provider Name (Legal Business Name): PHILIP ALI AFSHAR DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2018
Last Update Date: 08/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 MARKET ST LBBY 100
PHILADELPHIA PA
19103-3602
US

IV. Provider business mailing address

1818 MARKET ST LBBY 100
PHILADELPHIA PA
19103-3602
US

V. Phone/Fax

Practice location:
  • Phone: 215-567-2666
  • Fax:
Mailing address:
  • Phone: 215-567-2666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS042415
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: