NPIMap

Organization Active NPI

Innovative Dental Services, P.C.

  • Dentist
  • Philadelphia, PA
National Provider Identifier
1003214875
Registry record updated Dec 10, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DS037628 Issued in PA
Legal business name
INNOVATIVE DENTAL SERVICES, P.C.
Practice address
7234 Rising Sun Ave
Philadelphia, PA 19111-3948
Phone
(215) 745-4313
Fax
(215) 745-4388
NPI assigned
Dec 10, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Olga Kandov, DMD
Title
Owner
Phone
(215) 745-4313

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X DS037628 PA Primary

Addresses

Primary practice location

7234 Rising Sun Ave
Philadelphia, PA 19111-3948

Mailing address

7234 Rising Sun Ave
Philadelphia, PA 19111-3948
Phone (215) 745-4313

National Provider Directory

National Provider Directory
Tax ID family
Innovative Dental Services PC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1418169600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1418169600000",
    "number": "1003214875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7234 RISING SUN AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191113948",
            "telephone_number": "215-745-4313",
            "fax_number": "215-745-4388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7234 RISING SUN AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191113948",
            "telephone_number": "215-745-4313",
            "fax_number": "215-745-4388"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE DENTAL SERVICES, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-10",
        "last_updated": "2014-12-10",
        "status": "A",
        "authorized_official_last_name": "KANDOV",
        "authorized_official_first_name": "OLGA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "215-745-4313",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "PA",
            "license": "DS037628",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.