Provider Demographics
NPI:1629469937
Name:AFFORDABLE DENTISTRY OF NORTH PHILADELPHIA .INC
Entity Type:Organization
Organization Name:AFFORDABLE DENTISTRY OF NORTH PHILADELPHIA .INC
Other - Org Name:PRODENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FOUNDER AND CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TAHIR
Authorized Official - Middle Name:
Authorized Official - Last Name:TAHIR FARID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-964-8396
Mailing Address - Street 1:1335 W. TABOR ROAD (SUITE 105)
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19141
Mailing Address - Country:US
Mailing Address - Phone:215-276-3369
Mailing Address - Fax:
Practice Address - Street 1:1335 W. TABOR ROAD (SUITE 105)
Practice Address - Street 2:(SUITE 105)
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-3038
Practice Address - Country:US
Practice Address - Phone:215-276-3369
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-09
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental