Park Avenue Dental Associates

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DS020611L Issued in PA

Legal business name

PARK AVENUE DENTAL ASSOCIATES

Practice address

134 S State Rd
Upper Darby, PA 19082-2902

Phone

(610) 789-2440

Fax

(610) 789-2442

NPI assigned

Dec 5, 2006

Last updated

Aug 22, 2020By 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

Said Hussien Mohamed-Ai, DDS

Title

Owner

Phone

(610) 789-2440

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1689732380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "134 S STATE RD",
            "city": "UPPER DARBY",
            "state": "PA",
            "postal_code": "190822902",
            "telephone_number": "610-789-2440",
            "fax_number": "610-789-2442"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "134 S STATE RD",
            "city": "UPPER DARBY",
            "state": "PA",
            "postal_code": "190822902",
            "telephone_number": "610-789-2440",
            "fax_number": "610-789-2442"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARK AVENUE DENTAL ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MOHAMED-AI",
        "authorized_official_first_name": "SAID",
        "authorized_official_middle_name": "HUSSIEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "610-789-2440",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS020611L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Upper Darby, PA
• Providers in Upper Darby, PA by specialty
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.