Provider Demographics
NPI:1902134422
Name:EBDLAHAD, PHILIP (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:
Last Name:EBDLAHAD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19601-3325
Mailing Address - Country:US
Mailing Address - Phone:610-478-9044
Mailing Address - Fax:610-478-9401
Practice Address - Street 1:236 N 5TH ST
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19601-3325
Practice Address - Country:US
Practice Address - Phone:610-478-9044
Practice Address - Fax:610-478-9401
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-20
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028620L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014310400002Medicaid