# PARK AVENUE DENTAL ASSOCIATES

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

## Provider details

- **NPI number:** 1689732380
- **Authorized official:** SAID HUSSIEN MOHAMED-AI DDS (OWNER)
- **Authorized official phone:** (610) 789-2440

## Contact information

- **Practice address:** 134 S STATE RD, UPPER DARBY, PA 19082-2902
- **Practice address phone:** (610) 789-2440
- **Practice address fax:** (610) 789-2442
- **Mailing address:** 134 S STATE RD, UPPER DARBY, PA 19082-2902
- **Mailing address phone:** (610) 789-2440
- **Mailing address fax:** (610) 789-2442

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | DS020611L | PA | Yes |

## Other

- **Enumeration date:** 12/05/2006
- **Last updated:** 08/22/2020