Healthcare Provider Details

I. General information

NPI: 1083074801
Provider Name (Legal Business Name): HOORFAR DENTAL GROUP SPRING HOUSE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2016
Last Update Date: 03/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 SUMNEYTOWN PIKE SUITE 101
SPRING HOUSE PA
19477-1011
US

IV. Provider business mailing address

909 SUMNEYTOWN PIKE SUITE 101
SPRING HOUSE PA
19477-1011
US

V. Phone/Fax

Practice location:
  • Phone: 215-643-5220
  • Fax:
Mailing address:
  • Phone: 215-643-5220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License NumberDS029513L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. MERSAD HOORFAR
Title or Position: OWNER
Credential: DMD
Phone: 215-643-5220