Provider Demographics
NPI:1295785129
Name:ARLINGTON FAMILY DENTAL CENTRE, PA
Entity type:Organization
Organization Name:ARLINGTON FAMILY DENTAL CENTRE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SIAVASH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHADDEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-277-8847
Mailing Address - Street 1:101 E RANDOL MILL RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-4610
Mailing Address - Country:US
Mailing Address - Phone:817-277-8847
Mailing Address - Fax:817-277-9550
Practice Address - Street 1:101 E RANDOL MILL RD
Practice Address - Street 2:SUITE 107
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-4610
Practice Address - Country:US
Practice Address - Phone:817-277-8847
Practice Address - Fax:817-277-9550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty