Provider Demographics
NPI:1669502159
Name:ARIEL DENTAL LLC
Entity Type:Organization
Organization Name:ARIEL DENTAL LLC
Other - Org Name:SCRIMALLI RATCHFORD LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BIJAN
Authorized Official - Middle Name:REZA
Authorized Official - Last Name:AHMADZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:570-689-2449
Mailing Address - Street 1:358 HAMLIN HWY, STE 2
Mailing Address - Street 2:
Mailing Address - City:LAKE ARIEL
Mailing Address - State:PA
Mailing Address - Zip Code:18436
Mailing Address - Country:US
Mailing Address - Phone:570-689-2449
Mailing Address - Fax:866-658-1522
Practice Address - Street 1:358 HAMLIN HWY, STE 2
Practice Address - Street 2:
Practice Address - City:LAKE ARIEL
Practice Address - State:PA
Practice Address - Zip Code:18436
Practice Address - Country:US
Practice Address - Phone:570-689-2449
Practice Address - Fax:866-658-1522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1223G0001X
PADS026338L122300000X
PADS024178L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty