Provider Demographics
NPI:1457330375
Name:NATHANSON, ALAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:
Last Name:NATHANSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2578 ORTHODOX ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19137-1636
Mailing Address - Country:US
Mailing Address - Phone:215-533-7175
Mailing Address - Fax:215-533-6026
Practice Address - Street 1:2578 ORTHODOX ST
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19137-1636
Practice Address - Country:US
Practice Address - Phone:215-533-7175
Practice Address - Fax:215-533-6026
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS021460L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA232440843OtherFED TAX ID