Organization
EASY DENTAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ILYA IMYANITOV (MANAGING DIRECTOR)
(201) 637-1357
Entity
Organization
Contact information
Practice address
5616 GERMANTOWN AVE, PHILADELPHIA, PA 19144-2228
(267) 335-2181
(215) 821-2327
Mailing address
551 ADAMS AVE, PHILADELPHIA, PA 19120
(215) 268-3344
(215) 821-2327
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
08/01/2011
Last updated
10/09/2011
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