Provider Demographics
NPI:1184142416
Name:HUNTINGDON VALLEY DENTISTRY, P.C.
Entity type:Organization
Organization Name:HUNTINGDON VALLEY DENTISTRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAMLOO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:215-803-7068
Mailing Address - Street 1:2600 PHILMONT AVE STE 114
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-5307
Mailing Address - Country:US
Mailing Address - Phone:215-947-4910
Mailing Address - Fax:
Practice Address - Street 1:2600 PHILMONT AVE STE 114
Practice Address - Street 2:
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-5307
Practice Address - Country:US
Practice Address - Phone:215-947-4910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty