Organization
NORTHEAST DENTAL CENTER, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. OLEG AMAYEV (OWNER)
(215) 552-9800
Entity
Organization
Contact information
Practice address
10847 BUSTLETON AVE, PHILADELPHIA, PA 19116-3301
(215) 552-9800
Mailing address
10847 BUSTLETON AVE, PHILADELPHIA, PA 19116-3301
(215) 552-9800
(215) 552-9876
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DS036113
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1010462950001
—
PA
Enumeration date
06/26/2008
Last updated
10/17/2011
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