MEDICARE: ZAHNARZT DENTAL PC

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	261QD0000X	Dental Clinic/Center	DS037576	PA

General Provider Information

NPI Number	:	1508306408
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ZAHNARZT DENTAL PC

Provider Business Mailing Address
First Line	:	11621 BUSTLETON AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19116-2513
Country	:	US
Telephone Number	:	215-673-8887
Fax Number	:	215-673-9680

Provider Business Practice Location Address
First Line	:	11621 BUSTLETON AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19116-2513
Country	:	US
Telephone Number	:	215-673-8887
Fax Number	:	215-673-9680

Authorized Official
Title or Position	:	OWNER
Name	:	EUGENE J GROSS
Credential	:	DDS
Telephone Number	:	215-673-8887

Provider Enumeration Date	:	02/27/2017
Last Update Date	:	02/27/2017

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Directions to “ZAHNARZT DENTAL PC ” Practice Location

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