# PREMIER DENTISTRY OF PHILADELPHIA LLC

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

## Provider details

- **NPI number:** 1679918817
- **Authorized official:** DR. SHAHRAM SHAMLOO DMD (OWNER/DENTIST)
- **Authorized official phone:** (215) 564-1025

## Contact information

- **Practice address:** 1601 WALNUT ST, SUITE 1025, PHILADELPHIA, PA 19102-2944
- **Practice address phone:** (215) 564-1025
- **Practice address fax:** (215) 564-1027
- **Mailing address:** 1601 WALNUT ST, SUITE 1025, PHILADELPHIA, PA 19102-2944
- **Mailing address phone:** (215) 564-1025
- **Mailing address fax:** (215) 564-1027

## Taxonomy

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

## Other

- **Enumeration date:** 05/01/2013
- **Last updated:** 05/01/2013