NPIMap

Organization Active NPI

Innovative Dental Services, P.C.

  • Dentist
  • Philadelphia, PA
National Provider Identifier
1811345275
Registry record updated May 26, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DS037628 Issued in PA
Legal business name
INNOVATIVE DENTAL SERVICES, P.C.
Practice address
5737 N Broad St
Philadelphia, PA 19141-2307
Phone
(215) 275-6313
Fax
(215) 695-5511
NPI assigned
May 26, 2016
Last updated
May 26, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 26, 2016

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

Authorized official

Name
Dr. Olga Kandov, DMDNPI 1821248873
Title
Owner
Phone
(215) 275-6313

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
Dentist 122300000X DS037628 PA Primary

Addresses

Primary practice location

5737 N Broad St
Philadelphia, PA 19141-2307

Mailing address

1535 Sweetbriar Dr
Jamison, PA 18929-1653
Phone (215) 275-6313

National Provider Directory

National Provider Directory
Tax ID family
Innovative Dental Services PC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

5737 N Broad St
Philadelphia, PA 19141
Phone (215) 275-6313

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1464220800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1464220800000",
    "number": "1811345275",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1535 SWEETBRIAR DR",
            "city": "JAMISON",
            "state": "PA",
            "postal_code": "189291653",
            "telephone_number": "215-275-6313",
            "fax_number": "215-695-5511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5737 N BROAD ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191412307",
            "telephone_number": "215-275-6313",
            "fax_number": "215-695-5511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE DENTAL SERVICES, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-26",
        "last_updated": "2016-05-26",
        "status": "A",
        "authorized_official_last_name": "KANDOV",
        "authorized_official_first_name": "OLGA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "215-275-6313",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "PA",
            "license": "DS037628",
            "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 May 26, 2016; 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.