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General NPI Number Information
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NPI Number | 1457621559
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Entity Type | Organization
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Legal Business Name | PAOLI FAMILY DENTISTRY LLC
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Dates
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Enumeration Date | 01/05/2012
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Last Update Date | 01/05/2012
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Provider Practice Location Address
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Address Line | 1410 RUSSELL ROAD SUITE 203
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City | PAOLI
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State | PA
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Zip | 19301
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Country | US
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Telephone | 610-647-0353
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Fax | 610-647-3946
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Provider Business Mailing Address
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Address Line | 1410 RUSSELL ROAD SUITE 203
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City | PAOLI
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State | PA
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Zip | 19301
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Country | US
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Telephone | 610-647-0353
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Fax | 610-647-3946
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | MICHAEL SEPEHR AGUBEGI
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Credential | DMD
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Telephone | 610-647-0353
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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 | DS020247L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DS037487
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DS-030859-L
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License Number State | PA
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