Provider Demographics
NPI:1376076166
Name:NORTHPARK DENTAL GROUP LLC
Entity Type:Organization
Organization Name:NORTHPARK DENTAL GROUP LLC
Other - Org Name:NORTHPARK AESTHETIC DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:AKASH
Authorized Official - Middle Name:
Authorized Official - Last Name:BAROT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:215-335-2220
Mailing Address - Street 1:7519 TORRESDALE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19136-3335
Mailing Address - Country:US
Mailing Address - Phone:215-335-2220
Mailing Address - Fax:215-335-4340
Practice Address - Street 1:6239 FRANKFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19135-3404
Practice Address - Country:US
Practice Address - Phone:215-333-8441
Practice Address - Fax:215-333-8442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-07
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS040036261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental