Healthcare Provider Details

I. General information

NPI: 1295119188
Provider Name (Legal Business Name): MARINELA PRIFTI PHDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2015
Last Update Date: 05/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4510 FRANKFORD AVE
PHILADELPHIA PA
19124
US

IV. Provider business mailing address

1401 S 31ST ST
PHILADELPHIA PA
19146-3506
US

V. Phone/Fax

Practice location:
  • Phone: 215-535-1990
  • Fax: 215-535-1935
Mailing address:
  • Phone: 215-925-2400
  • Fax: 215-925-9162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH070701
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: