# NEWAGEDENTAL II PC

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

## Provider details

- **NPI number:** 1568257681
- **Authorized official:** KIRILL VASILYEV (DDS)
- **Authorized official phone:** (917) 650-6200

## Contact information

- **Practice address:** 9733 BUSTLETON AVE, PHILADELPHIA, PA 19115-3231
- **Practice address phone:** (215) 774-5050
- **Practice address fax:** (215) 437-7874
- **Mailing address:** 9733 BUSTLETON AVE, PHILADELPHIA, PA 19115-3231
- **Mailing address phone:** (215) 774-5050
- **Mailing address fax:** (215) 437-7874

## Taxonomy

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

## Other

- **Enumeration date:** 04/10/2025
- **Last updated:** 04/10/2025