The Dental Pavilion Inc

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DS027201L Issued in PA

Legal business name

THE DENTAL PAVILION INC

Practice address

4613 Baltimore Ave
Philadelphia, PA 19143

Phone

(215) 386-0334

Fax

(215) 386-9323

NPI assigned

May 19, 2008

Last updated

May 19, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Erik D. Williams, DMD

Title

Dentist Ceo

Phone

(215) 386-0334

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1211155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211155200000",
    "number": "1407013311",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4613 BALTIMORE AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19143",
            "telephone_number": "215-386-0334",
            "fax_number": "215-386-9323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4613 BALTIMORE AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19143",
            "telephone_number": "215-386-0334",
            "fax_number": "215-386-9323"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE DENTAL PAVILION INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-19",
        "last_updated": "2008-05-19",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "ERIK",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "DENTIST CEO",
        "authorized_official_telephone_number": "215-386-0334",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS027201L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2008; 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.