Provider Demographics
NPI:1831426170
Name:FRANKLIN MILLS MALL DENTAL
Entity type:Organization
Organization Name:FRANKLIN MILLS MALL DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHREYAS
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:215-632-7700
Mailing Address - Street 1:1120 FRANLKIN MILLS CIRCLE
Mailing Address - Street 2:FRANKLIN MILLS DENTAL
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19154
Mailing Address - Country:US
Mailing Address - Phone:215-632-7700
Mailing Address - Fax:215-632-7709
Practice Address - Street 1:1120 FRANKLIN MILLS CIR
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19154-3128
Practice Address - Country:US
Practice Address - Phone:215-632-7700
Practice Address - Fax:215-632-7709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-06
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS037098122300000X
PADS037088122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty