# ACADEMY DENISTRY GROUP

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

## Provider details

- **NPI number:** 1679053177
- **Authorized official:** MR. MARK E MILLER (CFO)
- **Authorized official phone:** (856) 905-1282

## Contact information

- **Practice address:** 10101 ACADEMY RD STE 2, PHILADELPHIA, PA 19114-1120
- **Practice address phone:** (215) 637-5800
- **Practice address fax:** (215) 637-6704
- **Mailing address:** 10101 ACADEMY RD STE 2, PHILADELPHIA, PA 19114-1120
- **Mailing address phone:** (215) 637-5800
- **Mailing address fax:** (215) 637-6704

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 08/15/2018
- **Last updated:** 08/15/2018