# PROSPECT PARK FAMILY DENTISTRY PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1023887908
- **Authorized official:** MR. KETAV SHAH (OWNER)
- **Authorized official phone:** (610) 583-5052

## Contact information

- **Practice address:** 907 LINCOLN AVE, PROSPECT PARK, PA 19076-1414
- **Practice address phone:** (610) 583-5052
- **Mailing address:** 907 LINCOLN AVE, PROSPECT PARK, PA 19076-1414
- **Mailing address phone:** (610) 583-5052

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 12/20/2023
- **Last updated:** 12/20/2023