Provider Demographics
NPI:1770027989
Name:TEAM DENTAL N LIBERTIES, LLC
Entity Type:Organization
Organization Name:TEAM DENTAL N LIBERTIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MURTUZA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAFFARI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:215-589-5100
Mailing Address - Street 1:992 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19123-2313
Mailing Address - Country:US
Mailing Address - Phone:215-589-5100
Mailing Address - Fax:215-515-3685
Practice Address - Street 1:992 N 2ND ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19123-2313
Practice Address - Country:US
Practice Address - Phone:215-589-5100
Practice Address - Fax:215-515-3685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-06
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ245471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty