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General NPI Number Information
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NPI Number | 1447148598
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Entity Type | Organization
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Legal Business Name | PHILADELPHIA DENTAL
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Dates
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Enumeration Date | 06/26/2025
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Last Update Date | 06/26/2025
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Provider Practice Location Address
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Address Line | 1625 CHESTNUT ST STE 228
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City | PHILADELPHIA
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State | PA
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Zip | 19103-4216
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Country | US
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Telephone | 215-336-8399
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Fax |
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Provider Business Mailing Address
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Address Line | 1732 S BROAD ST
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City | PHILADELPHIA
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State | PA
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Zip | 19145-2330
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Country | US
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Telephone | 215-336-8391
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | ARTYOM SHARBATYAN
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Credential |
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Telephone | 215-336-8391
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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 |
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License Number State |
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