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General NPI Number Information
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NPI Number | 1245611672
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Entity Type | Organization
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Legal Business Name | IDENTAL, PC
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Dates
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Enumeration Date | 06/11/2015
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Last Update Date | 06/11/2015
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Provider Practice Location Address
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Address Line | 2601 E ALLEGHENY AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19134-5103
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Country | US
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Telephone | 267-262-2834
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Fax |
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Provider Business Mailing Address
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Address Line | 2601 E ALLEGHENY AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19134-5103
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Country | US
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Telephone | 267-262-2834
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ZALIYA AKBASHEVA
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Credential |
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Telephone | 267-262-2834
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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 | DS037477
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License Number State | PA
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