Provider Demographics
NPI:1083074801
Name:HOORFAR DENTAL GROUP SPRING HOUSE LLC
Entity Type:Organization
Organization Name:HOORFAR DENTAL GROUP SPRING HOUSE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MERSAD
Authorized Official - Middle Name:
Authorized Official - Last Name:HOORFAR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:215-643-5220
Mailing Address - Street 1:909 SUMNEYTOWN PIKE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SPRING HOUSE
Mailing Address - State:PA
Mailing Address - Zip Code:19477-1011
Mailing Address - Country:US
Mailing Address - Phone:215-643-5220
Mailing Address - Fax:
Practice Address - Street 1:909 SUMNEYTOWN PIKE
Practice Address - Street 2:SUITE 101
Practice Address - City:SPRING HOUSE
Practice Address - State:PA
Practice Address - Zip Code:19477-1011
Practice Address - Country:US
Practice Address - Phone:215-643-5220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-07
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029513L261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental