Healthcare Provider Details

I. General information

NPI: 1558985317
Provider Name (Legal Business Name): OXFORD DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2020
Last Update Date: 06/07/2020
Certification Date: 06/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5233 OXFORD AVE
PHILADELPHIA PA
19124-1803
US

IV. Provider business mailing address

1015 THRUSH LN
HUNTINGDON VALLEY PA
19006-2027
US

V. Phone/Fax

Practice location:
  • Phone: 267-671-7380
  • Fax:
Mailing address:
  • Phone: 267-671-7380
  • Fax:

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: FATBARDHA ALIAJ
Title or Position: PRESIDENT
Credential: DMD
Phone: 267-671-7380