Provider Demographics
NPI:1336948785
Name:MAIN STREET DENTAL CENTER PLLC
Entity type:Organization
Organization Name:MAIN STREET DENTAL CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DMD OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANJELIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTI BAGDASAROV
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:305-632-9942
Mailing Address - Street 1:307 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-2604
Mailing Address - Country:US
Mailing Address - Phone:610-489-2037
Mailing Address - Fax:
Practice Address - Street 1:307 E MAIN ST
Practice Address - Street 2:
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426-2604
Practice Address - Country:US
Practice Address - Phone:610-489-2037
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental