Provider Demographics
NPI:1275832743
Name:PARVEENSULTANADMDPC
Entity Type:Organization
Organization Name:PARVEENSULTANADMDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:PARVEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SULTANA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:518-534-2855
Mailing Address - Street 1:275 S BRYN MAWR AVE
Mailing Address - Street 2:APT A19
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-4202
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2919 N 22ND ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19132-1505
Practice Address - Country:US
Practice Address - Phone:518-534-2855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-22
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0382741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty