NPIMap

Organization Active NPI

Advanced Dental Services, P.C

  • Dentist
  • Philadelphia, PA
National Provider Identifier
1508152919
Registry record updated Jun 23, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DS031011L Issued in PA
Legal business name
ADVANCED DENTAL SERVICES, P.C
Practice address
11880 Bustleton Ave Unit a
Philadelphia, PA 19116-2538
Phone
(215) 969-2015
NPI assigned
Jun 23, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2011

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

Authorized official

Name
Dmitry Karagodsky
Title
Owner/Dentist
Phone
(215) 696-2015

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X DS031011L PA Primary

Addresses

Primary practice location

11880 Bustleton Ave Unit a
Philadelphia, PA 19116-2538

Mailing address

11880 Bustleton Ave Unit a
Philadelphia, PA 19116-2538

National Provider Directory

National Provider Directory

Locations

11880 Bustleton Ave
Ste A
Philadelphia, PA 19116
Phone (215) 969-2015

NPI Registry JSON

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

{
    "created_epoch": "1308787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1308787200000",
    "number": "1508152919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11880 BUSTLETON AVE UNIT A",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191162538"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11880 BUSTLETON AVE UNIT A",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191162538",
            "telephone_number": "215-969-2015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED DENTAL SERVICES, P.C",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-23",
        "last_updated": "2011-06-23",
        "status": "A",
        "authorized_official_last_name": "KARAGODSKY",
        "authorized_official_first_name": "DMITRY",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "215-696-2015"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "PA",
            "license": "DS031011L",
            "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 Jun 23, 2011; 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.