Basic Information
| Provider Information | |||||||||
| NPI: | 1518203744 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PARADISE DENTAL,INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2338 N FRONT ST | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191333716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2678869474 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2338 N FRONT ST | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191333716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2678869474 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/16/2012 | ||||||||
| LastUpdateDate: | 06/10/2015 | ||||||||
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| AuthorizedOfficialLastName: | ARANBAYEV | ||||||||
| AuthorizedOfficialFirstName: | YEFIM | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2678869474 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223D0001X | Y | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist | Dental Public Health |
No ID Information.