NPIMap

Organization Active NPI

Main Street Dental Center City PC

  • General Practice Dentistry
  • Philadelphia, PA
National Provider Identifier
1639370661
Registry record updated Apr 22, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DS019673L Issued in PA
Legal business name
MAIN STREET DENTAL CENTER CITY PC
Practice address
1048 South St
Philadelphia, PA 19147-1935
Phone
(215) 627-1995
Fax
(215) 627-1999
NPI assigned
May 29, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2011

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

Authorized official

Name
Dr. Richard Victor Eidelson, DDS, FAGDNPI 1235344037
Title
President Dentist
Phone
(215) 627-1995

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X DS019673L PA Primary

Addresses

Primary practice location

1048 South St
Philadelphia, PA 19147-1935

Mailing address

1048 South St
Philadelphia, PA 19147-1935
Phone (215) 627-1995

National Provider Directory

National Provider Directory

Locations

1048 South St
Philadelphia, PA 19147
Phone (215) 627-1995

Practitioners & affiliated clinicians

Practitioners 1

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": "1180396800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1303430400000",
    "number": "1639370661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1048 SOUTH ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191471935",
            "telephone_number": "215-627-1995",
            "fax_number": "215-627-1999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1048 SOUTH ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191471935",
            "telephone_number": "215-627-1995",
            "fax_number": "215-627-1999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN STREET DENTAL CENTER CITY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-29",
        "last_updated": "2011-04-22",
        "status": "A",
        "authorized_official_last_name": "EIDELSON",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "VICTOR",
        "authorized_official_title_or_position": "PRESIDENT DENTIST",
        "authorized_official_telephone_number": "215-627-1995",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS, FAGD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS019673L",
            "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 Apr 22, 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.