Organization
BUSTLETON DENTAL CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TATYANA MIRTAJ (OWNER)
(267) 538-2627
Entity
Organization
Contact information
Practice address
11622 BUSTLETON AVE, PHILADELPHIA, PA 19116-2514
(267) 538-2627
Mailing address
11622 BUSTLETON AVE, PHILADELPHIA, PA 19116-2514
(267) 538-2627
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DS028963L
PA
Other
Enumeration date
02/21/2018
Last updated
02/21/2018
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