Provider Demographics
NPI:1184898587
Name:UNIVERSITY CITY DENTAL CENTER
Entity type:Organization
Organization Name:UNIVERSITY CITY DENTAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SULEIMAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:DZILALA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:215-476-2122
Mailing Address - Street 1:5338 BALTIMORE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-3117
Mailing Address - Country:US
Mailing Address - Phone:215-476-2122
Mailing Address - Fax:215-476-6863
Practice Address - Street 1:5338 BALTIMORE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143-3117
Practice Address - Country:US
Practice Address - Phone:215-476-2122
Practice Address - Fax:215-476-6863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS036647261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental