Provider Demographics
NPI:1336111293
Name:PHILIP EBDLAHAD DDS
Entity Type:Organization
Organization Name:PHILIP EBDLAHAD DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:EBDLAHAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-478-9044
Mailing Address - Street 1:236 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19601
Mailing Address - Country:US
Mailing Address - Phone:610-478-9044
Mailing Address - Fax:610-478-9401
Practice Address - Street 1:236 N 5TH ST
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19601
Practice Address - Country:US
Practice Address - Phone:610-478-9044
Practice Address - Fax:610-478-9401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-06
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028620L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014310400002Medicaid