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General NPI Number Information
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NPI Number | 1134537418
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Entity Type | Organization
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Legal Business Name | EASY DENTAL LLC
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Dates
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Enumeration Date | 07/30/2014
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Last Update Date | 07/30/2014
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Provider Practice Location Address
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Address Line | 5616 GERMANTOWN AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19144-2228
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Country | US
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Telephone | 267-335-2181
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Fax | 267-335-2188
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Provider Business Mailing Address
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Address Line | 5616 GERMANTOWN AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19144-2228
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Country | US
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Telephone | 267-335-2181
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Fax | 267-335-2188
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Authorized Official
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Title or Position | PRESIDENT
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Name | ELLEN PARASCHINA
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Credential |
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Telephone | 267-335-2181
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 636394
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License Number State | PA
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