| Modern Family Dental | |
|
1131 S 19th St Philadelphia PA 19146-2936 | |
| (215) 546-0388 | |
| Not Available |
| Full Name | Modern Family Dental |
|---|---|
| Speciality | Dentist |
| Location | 1131 S 19th St, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Nigar Aftab (OWNER) |
| Authorized Official Contact | 4846863723 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Modern Family Dental 1131 S 19th St Philadelphia PA 19146-2936 Ph: (215) 546-0388 | Modern Family Dental 1131 S 19th St Philadelphia PA 19146-2936 Ph: (215) 546-0388 |
| NPI Number | 1922404185 |
|---|---|
| Provider Enumeration Date | 11/14/2014 |
| Last Update Date | 11/14/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922404185 | NPI | - | NPPES |
| 0005290510001 | Medicaid | PA | |
| 102595694001 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | DS020595L (Pennsylvania) | Primary |
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