MEDICARE: PHILADELPHIA DENTAL

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

General Provider Information

NPI Number	:	1841789039
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHILADELPHIA DENTAL

Provider Business Mailing Address
First Line	:	1732 S BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19145-2330
Country	:	US
Telephone Number	:	215-336-8391
Fax Number	:	215-336-8392

Provider Business Practice Location Address
First Line	:	1732 S. BROAD ST.
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19145-2330
Country	:	US
Telephone Number	:	215-336-8391
Fax Number	:	215-336-8392

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	ARTYOM SHARBATYAN
Credential	:
Telephone Number	:	215-336-8391

Provider Enumeration Date	:	05/03/2018
Last Update Date	:	06/26/2025

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Directions to “PHILADELPHIA DENTAL ” Practice Location

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