Provider Demographics
NPI:1962527267
Name:DZILALA, SULEIMAN M II (DMD)
Entity type:Individual
Prefix:DR
First Name:SULEIMAN
Middle Name:M
Last Name:DZILALA
Suffix:II
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 UPLAND RD
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-3032
Mailing Address - Country:US
Mailing Address - Phone:610-853-8219
Mailing Address - Fax:610-853-8219
Practice Address - Street 1:5338 BALTIMORE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143-3117
Practice Address - Country:US
Practice Address - Phone:215-476-2122
Practice Address - Fax:215-476-6863
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0366471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101859920Medicaid