Provider Demographics
NPI:1104384155
Name:ABDELKADER FAMILY DENTISTRY
Entity Type:Organization
Organization Name:ABDELKADER FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDELKADER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:215-324-1746
Mailing Address - Street 1:358 E WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19120-4435
Mailing Address - Country:US
Mailing Address - Phone:215-324-1746
Mailing Address - Fax:215-324-5557
Practice Address - Street 1:358 E WYOMING AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19120-4435
Practice Address - Country:US
Practice Address - Phone:215-324-1746
Practice Address - Fax:215-324-5557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-08
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1028562350006Medicaid
PA0016789780001Medicaid