Provider Demographics
NPI:1033611843
Name:AFSHAR, PHILIP ALI (DMD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:ALI
Last Name:AFSHAR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 MARKET ST LBBY 100
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-3602
Mailing Address - Country:US
Mailing Address - Phone:215-567-2666
Mailing Address - Fax:
Practice Address - Street 1:1818 MARKET ST LBBY 100
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-3602
Practice Address - Country:US
Practice Address - Phone:215-567-2666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-07
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS042415122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist