Provider Demographics
NPI:1023470895
Name:DENTAL IMPLANT SOLUTIONS OF GREATER PHILADELPHIA, LLC
Entity type:Organization
Organization Name:DENTAL IMPLANT SOLUTIONS OF GREATER PHILADELPHIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:I.
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:FREEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:215-695-6666
Mailing Address - Street 1:1260 EASTON RD
Mailing Address - Street 2:
Mailing Address - City:ABINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19001-3128
Mailing Address - Country:US
Mailing Address - Phone:215-695-6666
Mailing Address - Fax:215-884-9085
Practice Address - Street 1:1260 EASTON RD
Practice Address - Street 2:
Practice Address - City:ABINGTON
Practice Address - State:PA
Practice Address - Zip Code:19001-3128
Practice Address - Country:US
Practice Address - Phone:215-695-6666
Practice Address - Fax:215-884-9085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026216L1223P0300X
PADS020755L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty