# UNITED DENTAL USA LLC

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

## Provider details

- **NPI number:** 1356714448
- **Authorized official:** JARED AYES (OPERATIONS MANAGER)
- **Authorized official phone:** (267) 774-5629

## Contact information

- **Practice address:** 1501 E WADSWORTH AVE, PHILADELPHIA, PA 19150-1605
- **Practice address phone:** (267) 774-5629
- **Practice address fax:** (267) 774-5639
- **Mailing address:** 1501 E WADSWORTH AVE, PHILADELPHIA, PA 19150-1605
- **Mailing address phone:** (267) 774-5629
- **Mailing address fax:** (267) 774-5639

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | DS019126L | PA | Yes |
| 1223G0001X | General Practice Dentistry | DS019126L | PA | — |

## Other

- **Enumeration date:** 11/11/2015
- **Last updated:** 11/11/2015