=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598069486
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALLEGHENY DENTAL 1
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/06/2011
-----------------------------------------------------
Last Update Date | 01/06/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2734 E ALLEGHENY AVE
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19134-5917
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-427-2786
-----------------------------------------------------
Fax | 215-427-2788
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2734 E ALLEGHENY AVE
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19134-5917
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-427-2786
-----------------------------------------------------
Fax | 215-427-2788
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL DIRECTOR
-----------------------------------------------------
Name | MRS. YEKATERINA ALOIAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 215-427-2786
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------