Provider Demographics
NPI:1356513949
Name:DENTAM INC
Entity type:Organization
Organization Name:DENTAM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEKSANDR
Authorized Official - Middle Name:V
Authorized Official - Last Name:MELEKHIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:215-332-6666
Mailing Address - Street 1:2471 NAPFLE ST # C
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-3855
Mailing Address - Country:US
Mailing Address - Phone:215-332-6666
Mailing Address - Fax:
Practice Address - Street 1:2471 NAPFLE ST # C
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-3855
Practice Address - Country:US
Practice Address - Phone:215-332-6666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028941L261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01475741Medicaid