# MODERN DENTISTRY AND COSMETOLOGY CENTER

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Modern Dentistry and Cosmetology Center PC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1386270841
- **Authorized official:** IRINA STEPANSKY DMD (OWNER)
- **Authorized official phone:** (215) 676-9050

## Contact information

- **Practice address:** 11911 BUSTLETON AVE, PHILADELPHIA, PA 19116-2541
- **Practice address phone:** (215) 673-9050
- **Mailing address:** 11911 BUSTLETON AVE, PHILADELPHIA, PA 19116-2541
- **Mailing address phone:** (215) 673-9050

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |
| 261Q00000X | Clinic/Center | — | NULL | — |
| 261QD0000X | Dental Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 03/17/2020
- **Last updated:** 03/17/2020