| NPI | 1629469937 |
|---|---|
| Doing Business As | PRODENTAL |
| Entity Type | Organization |
| Authorized Contact | TAHIR TAHIR FARID Founder And CEO 215-964-8396 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2015-02-09 |
| Last Update Date | 2015-02-11 |