Provider Demographics
NPI:1871793141
Name:PETER A. CILENTO, D.M.D. AND MARYAM SHOLEHVAR, D.M.D., LLC
Entity type:Organization
Organization Name:PETER A. CILENTO, D.M.D. AND MARYAM SHOLEHVAR, D.M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ANTHONY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-437-4486
Mailing Address - Street 1:1104 S CEDAR CREST BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-7901
Mailing Address - Country:US
Mailing Address - Phone:610-437-4486
Mailing Address - Fax:610-437-5071
Practice Address - Street 1:1104 S CEDAR CREST BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-7901
Practice Address - Country:US
Practice Address - Phone:610-437-4486
Practice Address - Fax:610-437-5071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA417742OtherDELTA DENTAL
PA142980OtherBLUE SHIELD