Healthcare Provider Details

I. General information

NPI: 1477334548
Provider Name (Legal Business Name): DAG FRANKFORD AVENUE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2023
Last Update Date: 10/13/2023
Certification Date: 10/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7052-56 FRANKFORD AVE
PHILADELPHIA PA
19135
US

IV. Provider business mailing address

7052-56 FRANKFORD AVE
PHILADELPHIA PA
19135
US

V. Phone/Fax

Practice location:
  • Phone: 267-463-2777
  • Fax: 215-463-5651
Mailing address:
  • Phone: 267-463-2777
  • Fax: 215-463-5651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: RAFAELA NEDELEA
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 267-334-0082