MEDICARE: AFFORDABLE DENTISTRY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DS036503	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DS036503	OTHER	PA	STATE LICENSE

General Provider Information

NPI Number	:	1285058008
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AFFORDABLE DENTISTRY LLC

Provider Business Mailing Address
First Line	:	1507 W PASSYUNK AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19145-3029
Country	:	US
Telephone Number	:	215-626-6298
Fax Number	:

Provider Business Practice Location Address
First Line	:	1507 W PASSYUNK AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19145-3029
Country	:	US
Telephone Number	:	215-626-6298
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. GEORGE HANNA
Credential	:	DMD
Telephone Number	:	215-626-6298

Provider Enumeration Date	:	02/13/2014
Last Update Date	:	02/13/2014

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Directions to “AFFORDABLE DENTISTRY LLC ” Practice Location

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