Provider Demographics
NPI:1063770378
Name:ACADEMY FAMILY DENTAL CARE
Entity type:Organization
Organization Name:ACADEMY FAMILY DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUNAID
Authorized Official - Middle Name:K
Authorized Official - Last Name:CHAUDHRY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:215-637-7474
Mailing Address - Street 1:10431 ACADEMY RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-1126
Mailing Address - Country:US
Mailing Address - Phone:215-637-7474
Mailing Address - Fax:215-637-4408
Practice Address - Street 1:10431 ACADEMY RD
Practice Address - Street 2:SUITE A
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1126
Practice Address - Country:US
Practice Address - Phone:215-637-7474
Practice Address - Fax:215-637-4408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADH070997124Q00000X
PADS029793L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADS029793LOtherDENTAL LICENSE STATE OF PENNSYLVANIA
PADS029793LOtherDENTAL LICENSE STATE OF PENNSYLVANIA