Provider Demographics
NPI:1942802699
Name:PORT RICHMOND DENTAL CENTER
Entity Type:Organization
Organization Name:PORT RICHMOND DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:FLIGELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-498-8854
Mailing Address - Street 1:3162 RICHMOND ST FL 1
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19134-5827
Mailing Address - Country:US
Mailing Address - Phone:215-739-8008
Mailing Address - Fax:215-739-8022
Practice Address - Street 1:3162 RICHMOND ST FL 1
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-5827
Practice Address - Country:US
Practice Address - Phone:157-398-0082
Practice Address - Fax:215-739-8022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-09
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty