# MOUNT AIRY FAMILY DENTAL LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1508490509
- **Authorized official:** MADHVI PATEL (PARTNER)
- **Authorized official phone:** (952) 649-9817

## Contact information

- **Practice address:** 1600 IVY HILL RD, PHILADELPHIA, PA 19150-1008
- **Practice address phone:** (952) 649-9817
- **Mailing address:** 1600 IVY HILL RD, PHILADELPHIA, PA 19150-1008
- **Mailing address phone:** (215) 248-1404

## Taxonomy

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

## Other

- **Enumeration date:** 02/27/2020
- **Last updated:** 06/14/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 103246221 | — | PA |