Provider Demographics
NPI:1043807522
Name:TOWN DENTAL PC
Entity type:Organization
Organization Name:TOWN DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OLEG
Authorized Official - Middle Name:
Authorized Official - Last Name:AMAYEV
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:215-333-8100
Mailing Address - Street 1:6412 FRANKFORD AVE UNIT 10
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19135-3005
Mailing Address - Country:US
Mailing Address - Phone:215-333-8100
Mailing Address - Fax:215-333-8111
Practice Address - Street 1:6412 FRANKFORD AVE UNIT 10
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19135-3005
Practice Address - Country:US
Practice Address - Phone:215-333-8100
Practice Address - Fax:215-333-8111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental