# PAOLI FAMILY DENTISTRY LLC

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

## Provider details

- **NPI number:** 1457621559
- **Authorized official:** MICHAEL SEPEHR AGUBEGI DMD (DENTIST/OWNER)
- **Authorized official phone:** (610) 647-0353

## Contact information

- **Practice address:** 1410 RUSSELL ROAD, SUITE 203, PAOLI, PA 19301
- **Practice address phone:** (610) 647-0353
- **Practice address fax:** (610) 647-3946
- **Mailing address:** 1410 RUSSELL ROAD, SUITE 203, PAOLI, PA 19301
- **Mailing address phone:** (610) 647-0353
- **Mailing address fax:** (610) 647-3946

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | DS-030859-L | PA | Yes |
| 1223G0001X | General Practice Dentistry | DS020247L | PA | — |
| 1223G0001X | General Practice Dentistry | DS037487 | PA | — |

## Other

- **Enumeration date:** 01/05/2012
- **Last updated:** 01/05/2012