Provider Demographics
NPI:1477334548
Name:DAG FRANKFORD AVENUE PC
Entity Type:Organization
Organization Name:DAG FRANKFORD AVENUE PC
Other - Org Name:INNOVATIVE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:RAFAELA
Authorized Official - Middle Name:
Authorized Official - Last Name:NEDELEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-334-0082
Mailing Address - Street 1:7052-56 FRANKFORD AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19135
Mailing Address - Country:US
Mailing Address - Phone:267-463-2777
Mailing Address - Fax:215-463-5651
Practice Address - Street 1:7052-56 FRANKFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19135
Practice Address - Country:US
Practice Address - Phone:267-463-2777
Practice Address - Fax:215-463-5651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-13
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty