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General NPI Number Information
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NPI Number | 1164972451
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Entity Type | Organization
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Legal Business Name | HOORFAR DENTAL GROUP-SPRING GARDEN LLC
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Dates
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Enumeration Date | 10/11/2016
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Last Update Date | 10/11/2016
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Provider Practice Location Address
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Address Line | 1825 SPRING GARDEN ST
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City | PHILADELPHIA
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State | PA
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Zip | 19130-3916
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Country | US
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Telephone | 215-972-0965
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Fax |
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Provider Business Mailing Address
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Address Line | 1825 SPRING GARDEN ST
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City | PHILADELPHIA
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State | PA
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Zip | 19130-3916
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Country | US
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Telephone | 215-972-0965
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MARIELLEN HANLIN
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Credential |
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Telephone | 215-643-5220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DS 029513L
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License Number State | PA
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