Provider Demographics
NPI:1154868842
Name:DENTEX DENTAL AT LIBERTY LLC
Entity type:Organization
Organization Name:DENTEX DENTAL AT LIBERTY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:ALOIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-336-8399
Mailing Address - Street 1:1625 CHESTNUT ST
Mailing Address - Street 2:STE 228
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-4206
Mailing Address - Country:US
Mailing Address - Phone:215-336-8399
Mailing Address - Fax:216-336-8396
Practice Address - Street 1:3035 FRANKS RD
Practice Address - Street 2:
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-4216
Practice Address - Country:US
Practice Address - Phone:215-914-2157
Practice Address - Fax:215-914-2298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-19
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty