Organization
ADVANCED FAMILY DENTISTRY, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PHI LE (CREDENTIALING SPECIALIST)
(267) 460-4254
Entity
Organization
Contact information
Practice address
6100-02 5TH STREET, STOREFRONT, PHILADELPHIA, PA 19120
(215) 224-4343
(215) 646-6369
Mailing address
401 COMMERCE DR, SUITE 108, FORT WASHINGTON, PA 19034-2714
(267) 460-4254
(215) 646-6369
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DS-029417-L
PA
Other
Enumeration date
06/07/2011
Last updated
06/07/2011
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