Organization
MONTGOMERY MALL DENTAL, LLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VIKTORIYA I SHAAKOVA (OFFICE MANAGER)
(215) 362-5666
Entity
Organization
Contact information
Practice address
154 MONTGOMERY MALL, NORTH WALES, PA 19454-3909
(215) 356-6666
Mailing address
154 MONTGOMERY MALL, NORTH WALES, PA 19454-3909
(215) 356-6666
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DS038562
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
193200000X
MULTI-SPECIALTY GROUP
PA
Enumeration date
01/25/2013
Last updated
01/25/2013
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