Provider Demographics
NPI:1144532128
Name:SULTANA, PARVEEN
Entity type:Individual
Prefix:DR
First Name:PARVEEN
Middle Name:
Last Name:SULTANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 SPRUCE ST
Mailing Address - Street 2:APT 401
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4059
Mailing Address - Country:US
Mailing Address - Phone:518-534-2855
Mailing Address - Fax:
Practice Address - Street 1:826 BUSTLETON PIKE
Practice Address - Street 2:STE 105
Practice Address - City:FEASTERVILLE TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-6064
Practice Address - Country:US
Practice Address - Phone:518-534-2855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS038274122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist