Provider Demographics
NPI:1982221636
Name:PROFKA, ALDO (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALDO
Middle Name:
Last Name:PROFKA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3339 OAKMONT ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19136-3510
Mailing Address - Country:US
Mailing Address - Phone:215-410-6708
Mailing Address - Fax:
Practice Address - Street 1:261 OLD YORK RD STE 330
Practice Address - Street 2:
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-3710
Practice Address - Country:US
Practice Address - Phone:215-885-2202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-29
Last Update Date:2021-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0427641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice