NPIMap

Organization Active NPI

CD Pennsylvania Dental, P.C.

  • Dentist
  • Philadelphia, PA
National Provider Identifier
1174015671
Registry record updated Jun 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
CD PENNSYLVANIA DENTAL, P.C.
Practice address
6012 Greene St
Philadelphia, PA 19144-2726
Phone
(215) 843-9400
Fax
(215) 843-3237
NPI assigned
May 31, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2025

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

Authorized official

Name
Ty Justice
Title
Director, Credentialing & Payer Rel
Phone
(512) 808-4984

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X Primary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X

Addresses

Primary practice location

6012 Greene St
Philadelphia, PA 19144-2726

Mailing address

9825 Kenwood Rd Ste 200
Blue Ash, OH 45242-6252
Phone (513) 609-4076

Other names 2

  • Drs. Melman, Ravett & Associates Doing business as
  • Greene Street Dental Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1527724800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1751241600000",
    "number": "1174015671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9825 KENWOOD RD STE 200",
            "city": "BLUE ASH",
            "state": "OH",
            "postal_code": "452426252",
            "telephone_number": "513-609-4076",
            "fax_number": "513-448-0511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6012 GREENE ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191442726",
            "telephone_number": "215-843-9400",
            "fax_number": "215-843-3237"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CD PENNSYLVANIA DENTAL, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-31",
        "last_updated": "2025-06-30",
        "certification_date": "2025-06-30",
        "status": "A",
        "authorized_official_last_name": "JUSTICE",
        "authorized_official_first_name": "TY",
        "authorized_official_title_or_position": "DIRECTOR, CREDENTIALING & PAYER REL",
        "authorized_official_telephone_number": "512-808-4984"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Drs. Melman, Ravett & Associates",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Greene Street Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jun 30, 2025; 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.