Healthcare Provider Details

I. General information

NPI: 1407223811
Provider Name (Legal Business Name): IRINA ZAGORODNY D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2015
Last Update Date: 09/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3428 RHAWN ST
PHILADELPHIA PA
19136-2610
US

IV. Provider business mailing address

1050 BYBERRY RD
HUNTINGDON VALLEY PA
19006-3815
US

V. Phone/Fax

Practice location:
  • Phone: 215-331-1330
  • Fax:
Mailing address:
  • Phone: 215-900-9560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS040472
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: