# NORTHEAST DENTAL CENTER, P.C.

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

## Provider details

- **NPI number:** 1992967475
- **Authorized official:** DR. OLEG AMAYEV (OWNER)
- **Authorized official phone:** (215) 552-9800

## Contact information

- **Practice address:** 10847 BUSTLETON AVE, PHILADELPHIA, PA 19116-3301
- **Practice address phone:** (215) 552-9800
- **Mailing address:** 10847 BUSTLETON AVE, PHILADELPHIA, PA 19116-3301
- **Mailing address phone:** (215) 552-9800
- **Mailing address fax:** (215) 552-9876

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | DS036113 | PA | Yes |

## Other

- **Enumeration date:** 06/26/2008
- **Last updated:** 10/17/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1010462950001 | — | PA |