=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871793141
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PETER A. CILENTO, D.M.D. AND MARYAM SHOLEHVAR, D.M.D., LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/24/2007
-----------------------------------------------------
Last Update Date | 07/24/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1104 S CEDAR CREST BLVD SUITE 100
-----------------------------------------------------
City | ALLENTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18103-7901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-437-4486
-----------------------------------------------------
Fax | 610-437-5071
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1104 S CEDAR CREST BLVD SUITE 100
-----------------------------------------------------
City | ALLENTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18103-7901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-437-4486
-----------------------------------------------------
Fax | 610-437-5071
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATIVE ASSISTANT
-----------------------------------------------------
Name | LINDA LEE ANTHONY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 610-437-4486
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0700X
-----------------------------------------------------
Taxonomy Name | Prosthodontics
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------