Provider Demographics
NPI:1386773075
Name:COSMETIC AND FAMILY DENTISTRY
Entity type:Organization
Organization Name:COSMETIC AND FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HANI
Authorized Official - Middle Name:
Authorized Official - Last Name:ELMIMEH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:267-265-1751
Mailing Address - Street 1:5810 GREENE STREET
Mailing Address - Street 2:SUITE #1
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-2761
Mailing Address - Country:US
Mailing Address - Phone:215-438-1100
Mailing Address - Fax:484-383-0796
Practice Address - Street 1:5810 GREENE STREET
Practice Address - Street 2:SUITE #1
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-2761
Practice Address - Country:US
Practice Address - Phone:215-438-1100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental