Organization
FRANFORD AVE DENTAL GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHANTI KIDAMBI (MANAGER)
(610) 876-3300
Entity
Organization
Contact information
Practice address
7538 FRANKFORD AVE, PHILADELPHIA, PA 19136-3533
(215) 333-4744
Mailing address
7538 FRANKFORD AVE, PHILADELPHIA, PA 19136-3533
(215) 333-4744
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
DS038385
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DS038385
STATE LICENSE
PA
Enumeration date
11/09/2017
Last updated
06/16/2018
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