Provider Demographics
NPI:1184826042
Name:FORT WASHINGTON FAMILY & COSMETIC DENTISTRY
Entity Type:Organization
Organization Name:FORT WASHINGTON FAMILY & COSMETIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DMD
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:MIRTAJ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-643-0300
Mailing Address - Street 1:428 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-3413
Mailing Address - Country:US
Mailing Address - Phone:215-643-0300
Mailing Address - Fax:
Practice Address - Street 1:428 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034-3413
Practice Address - Country:US
Practice Address - Phone:215-643-0300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADX0018401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty