Healthcare Provider Details

I. General information

NPI: 1992139059
Provider Name (Legal Business Name): ACE DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2013
Last Update Date: 08/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5616 GERMANTOWN AVE
PHILADELPHIA PA
19144-2228
US

IV. Provider business mailing address

3554 HULMEVILLE RD STE 110
BENSALEM PA
19020-4366
US

V. Phone/Fax

Practice location:
  • Phone: 215-383-9800
  • Fax: 215-383-0115
Mailing address:
  • Phone: 215-383-9800
  • Fax: 215-383-0115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS036680
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS036660
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State

VIII. Authorized Official

Name: DR. SONIA KAHLON
Title or Position: OWNER/ORTHODONTIST
Credential: DMD
Phone: 215-383-9800