Organization
FLAWLESS DENTAL GROUP, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ILYA IMYANITOV (DIRECTOR OF BUSINESS OPERATIONS)
(215) 268-3344
Entity
Organization
Contact information
Practice address
551 ADAMS AVE, PHILADELPHIA, PA 19120-2101
(215) 268-3344
(215) 821-2327
Mailing address
551 ADAMS AVE, PHILADELPHIA, PA 19120-2101
(215) 268-3344
(215) 821-2327
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DS027760L
PA
1223G0001X
General Practice Dentistry
DS027760L
PA
Other
Enumeration date
07/17/2014
Last updated
07/17/2014
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