Provider Demographics
NPI:1154740579
Name:DENTI DENTAL
Entity type:Organization
Organization Name:DENTI DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:IRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:STEPANSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:215-673-9050
Mailing Address - Street 1:3609 GERMANTOWN AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19140-4225
Mailing Address - Country:US
Mailing Address - Phone:267-616-4051
Mailing Address - Fax:215-673-9052
Practice Address - Street 1:3609 GERMANTOWN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-4225
Practice Address - Country:US
Practice Address - Phone:267-616-4051
Practice Address - Fax:215-673-9052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-14
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029548L305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization