Provider Demographics
NPI:1932604089
Name:GOOD SHEPHERD DENTAL CARE PLLC
Entity Type:Organization
Organization Name:GOOD SHEPHERD DENTAL CARE PLLC
Other - Org Name:HAVERFORD SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:A
Authorized Official - Last Name:SOULIMAN
Authorized Official - Suffix:
Authorized Official - Credentials:BDS, DMD
Authorized Official - Phone:848-333-5550
Mailing Address - Street 1:600 HAVERFORD RD STE 202
Mailing Address - Street 2:
Mailing Address - City:HAVERFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19041-1139
Mailing Address - Country:US
Mailing Address - Phone:610-642-3009
Mailing Address - Fax:
Practice Address - Street 1:600 HAVERFORD RD STE 202
Practice Address - Street 2:
Practice Address - City:HAVERFORD
Practice Address - State:PA
Practice Address - Zip Code:19041-1139
Practice Address - Country:US
Practice Address - Phone:610-642-3009
Practice Address - Fax:610-642-2328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-29
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS039840261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental