Provider Demographics
NPI:1851089841
Name:PRO DENTAL GROUP PC
Entity Type:Organization
Organization Name:PRO DENTAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:KHAMIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BADALOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-313-1896
Mailing Address - Street 1:7025 BRISTOL PIKE
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19057-4707
Mailing Address - Country:US
Mailing Address - Phone:215-915-0505
Mailing Address - Fax:267-585-3341
Practice Address - Street 1:7025 BRISTOL PIKE
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:PA
Practice Address - Zip Code:19057-4707
Practice Address - Country:US
Practice Address - Phone:215-915-0505
Practice Address - Fax:267-585-3341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-27
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty