Provider Demographics
NPI:1902659006
Name:ORANGE ST DENTAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:ORANGE ST DENTAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAFAGH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:610-733-8877
Mailing Address - Street 1:2 S ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-2619
Mailing Address - Country:US
Mailing Address - Phone:610-572-3422
Mailing Address - Fax:
Practice Address - Street 1:2 S ORANGE ST
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-2619
Practice Address - Country:US
Practice Address - Phone:610-572-3422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental