# OVERBROOK FARMS DENTAL GROUP

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

## Provider details

- **NPI number:** 1568603744
- **Authorized official:** DR. MARY ROSTAMI DMD (DENTIST)
- **Authorized official phone:** (215) 878-0058

## Contact information

- **Practice address:** 2121 N 63RD ST, PHILADELPHIA, PA 19151-2612
- **Practice address phone:** (215) 878-0058
- **Practice address fax:** (215) 878-3834
- **Mailing address:** 2121 N 63RD ST, PHILADELPHIA, PA 19151-2612
- **Mailing address phone:** (215) 878-0058
- **Mailing address fax:** (215) 878-3834

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | DS029137L | PA | Yes |

## Other

- **Enumeration date:** 03/17/2009
- **Last updated:** 03/17/2009