Provider Demographics
NPI:1073846929
Name:PENN DENTAL CENTER PC
Entity Type:Organization
Organization Name:PENN DENTAL CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VIKAS
Authorized Official - Middle Name:
Authorized Official - Last Name:ARORA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:215-227-6700
Mailing Address - Street 1:2628 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19132-4015
Mailing Address - Country:US
Mailing Address - Phone:215-227-6700
Mailing Address - Fax:215-279-9103
Practice Address - Street 1:2628 N BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19132-4015
Practice Address - Country:US
Practice Address - Phone:215-227-6700
Practice Address - Fax:215-279-9103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-10
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS037724122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1022687430001Medicaid