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General NPI Number Information
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NPI Number | 1336948785
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Entity Type | Organization
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Legal Business Name | MAIN STREET DENTAL CENTER PLLC
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Dates
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Enumeration Date | 03/10/2025
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Last Update Date | 03/10/2025
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Provider Practice Location Address
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Address Line | 307 E MAIN ST
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City | COLLEGEVILLE
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State | PA
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Zip | 19426-2604
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Country | US
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Telephone | 610-489-2037
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Fax |
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Provider Business Mailing Address
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Address Line | 307 E MAIN ST
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City | COLLEGEVILLE
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State | PA
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Zip | 19426-2604
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Country | US
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Telephone | 610-489-2037
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Fax |
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Authorized Official
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Title or Position | DMD OWNER
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Name | DR. ANJELIKA MARTI BAGDASAROV
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Credential | DMD
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Telephone | 305-632-9942
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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