# FLAWLESS DENTAL GROUP, PC

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

## Provider details

- **NPI number:** 1538576921
- **Authorized official:** MR. ILYA IMYANITOV (DIRECTOR OF BUSINESS OPERATIONS)
- **Authorized official phone:** (215) 268-3344

## Contact information

- **Practice address:** 551 ADAMS AVE, PHILADELPHIA, PA 19120-2101
- **Practice address phone:** (215) 268-3344
- **Practice address fax:** (215) 821-2327
- **Mailing address:** 551 ADAMS AVE, PHILADELPHIA, PA 19120-2101
- **Mailing address phone:** (215) 268-3344
- **Mailing address fax:** (215) 821-2327

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | DS027760L | PA | Yes |
| 1223G0001X | General Practice Dentistry | DS027760L | PA | — |

## Other

- **Enumeration date:** 07/17/2014
- **Last updated:** 07/17/2014