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General NPI Number Information
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NPI Number | 1568257681
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Entity Type | Organization
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Legal Business Name | NEWAGEDENTAL II PC
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Dates
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Enumeration Date | 04/10/2025
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Last Update Date | 04/10/2025
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Provider Practice Location Address
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Address Line | 9733 BUSTLETON AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19115-3231
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Country | US
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Telephone | 215-774-5050
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Fax | 215-437-7874
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Provider Business Mailing Address
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Address Line | 9733 BUSTLETON AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19115-3231
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Country | US
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Telephone | 215-774-5050
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Fax | 215-437-7874
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Authorized Official
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Title or Position | DDS
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Name | KIRILL VASILYEV
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Credential |
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Telephone | 917-650-6200
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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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