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Select Plan Provider Directory - Dominion Dental Services, Inc.

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SELECT PLAN 1 DENTIST DIRECTORY<br />

Dentists listed are under contract as of 10/1/12<br />

Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />

Lee Richard 001058 Richard Lee D.D.S. 214 2nd Street SE Washington DC 20003 General <strong>Provider</strong> District of Columbia<br />

Penn Shelton 000338 Shelton R Penn DDS 5 Barney Circle, S.E. Washington DC 20003 General <strong>Provider</strong> District of Columbia<br />

El Haje Emad 037585 Prosthetic and TMJ Management 1800 I Street, Suite 801 Washington DC 20006 General <strong>Provider</strong> District of Columbia<br />

Contract Sheldon 002665 Sheldon L. Contract, DDS, PC 1800 I Street NW, Suite 402 Washington DC 20006 Orthodontist District of Columbia<br />

Peretz A 002739 Georgetown Smile 4400 MacAuthur Blvd., Suite 200 Washington DC 20007 General <strong>Provider</strong> District of Columbia<br />

Landy Michael 000281 Michael G. Landy, D.D.S., F.A.G.D. 4600 Connecticut Ave. N.W. Washington DC 20008 General <strong>Provider</strong> District of Columbia<br />

Salameh Tareq 050841 Salameh <strong>Dental</strong> Associates 4444 Connecticut Ave. NW, Suite 106 Washington DC 20008 General <strong>Provider</strong> District of Columbia<br />

Sharmin Rahim 001691 Sharmin <strong>Dental</strong> Clinic/Rahim Sharmin, D.D.S. 1613 Harvard Street, NW, Suite 108 Washington DC 20009 General <strong>Provider</strong> District of Columbia<br />

George Delphine 050966 Smile <strong>Dental</strong> PC 2108 18th St NW, Suite 1 Washington DC 20009 General <strong>Provider</strong> District of Columbia<br />

Nallavalli Sravanthi 050966 Smile <strong>Dental</strong> PC 2108 18th St NW, Suite 1 Washington DC 20009 General <strong>Provider</strong> District of Columbia<br />

Said Hoda 050966 Smile <strong>Dental</strong> PC 2108 18th St NW, Suite 1 Washington DC 20009 General <strong>Provider</strong> District of Columbia<br />

Smith Stanley 050757 Stanley T Smith DDS PC 3609 Georgia Ave NW Washington DC 20010 General <strong>Provider</strong> District of Columbia<br />

Branch, III Maury 051048 Petworth <strong>Dental</strong> PLLC 4018 Georgia Ave NW Washington DC 20011 General <strong>Provider</strong> District of Columbia<br />

Miller Gregory 001659 Capitol City <strong>Dental</strong> Center 7723 Alaska Avenue, NW Washington DC 20012 General <strong>Provider</strong> District of Columbia<br />

Salameh Tareq 069560 Eastern Family <strong>Dental</strong> 7826 Eastern Ave NW, Suite 202 Washington DC 20012 General <strong>Provider</strong> District of Columbia<br />

Perry-Dodson Elizabeth 061282 Elizabeth Perry-Dodson DDS 7310 Alaska Ave NW Washington DC 20012 General <strong>Provider</strong> District of Columbia<br />

Roudsari Monireh 002769 Georgia Avenue <strong>Dental</strong> Clinic 7304 Georgia Ave. NW, Suite 2 Washington DC 20012 General <strong>Provider</strong> District of Columbia<br />

Branch, III Maury 051049 Petworth <strong>Dental</strong> PLLC 800 Butternut St NW Washington DC 20012 General <strong>Provider</strong> District of Columbia<br />

De La Cruz Carola 016667 Elidia C Fidel, D.D.S. PLP 5247 Wisconsin Avenue, Suite 3 A Washington DC 20015 Pedodontist District of Columbia<br />

Fidel Elidia 016667 Elidia C Fidel, D.D.S. PLP 5247 Wisconsin Avenue, Suite 3 A Washington DC 20015 Pedodontist District of Columbia<br />

Mallek Henry 000691 Henry Mallek,D.D.S. 4910 Massachusetts Ave., Suite 219 Washington DC 20016 Periodontist District of Columbia<br />

McNair Larry 050740 Larry F McNair DDS 2033 Hamlin Street, NE Washington DC 20018 General <strong>Provider</strong> District of Columbia<br />

Harrison Eric 037679 E G Harrison DMD 3230 Pennsylvania Ave SE Washington DC 20020 General <strong>Provider</strong> District of Columbia<br />

* Davidson, Jr. Alphonzo 000512 Hillcrest <strong>Dental</strong> Assoc. 2811 Pennsylvania Avenue Washington DC 20020 General <strong>Provider</strong> District of Columbia<br />

Baptiste Roy 001406 Roy Baptiste DDS 3130 MLK Ave, S.E. Washington DC 20032 General <strong>Provider</strong> District of Columbia<br />

Hood, III James 001406 Roy Baptiste DDS 3130 MLK Ave, S.E. Washington DC 20032 General <strong>Provider</strong> District of Columbia<br />

Walker Michael 001406 Roy Baptiste DDS 3130 MLK Ave, S.E. Washington DC 20032 General <strong>Provider</strong> District of Columbia<br />

Lasky Andrew 000185 Andrew M. Lasky, D.D.S., P.C. 1325 18th St. N.W. #201 Washington DC 20036 General <strong>Provider</strong> District of Columbia<br />

Gitelman Jeffrey 000614 Jeffrey Gitelman, D.D.S., P.C. 1234 19th St. N.W., Ste. 508 Washington DC 20036 Oral Surgeon District of Columbia<br />

Merlo Leonard 000614 Jeffrey Gitelman, D.D.S., P.C. 1234 19th St. N.W., Ste. 508 Washington DC 20036 Oral Surgeon District of Columbia<br />

Blumenkranz Uziel 002601 Uzeil Blumenkranz, D.D.S. 1234 19th Street, Suite 208 Washington DC 20036 Endodontist District of Columbia<br />

Doumit Antoine 061332 Antoine Doumit DMD CAGS PC 950 25th St NW Washington DC 20037 Orthodontist District of Columbia<br />

Eshraghi Bahram 000273 Yousefi Washington Clinic 3 Washington Circle, Suite G Washington DC 20037 General <strong>Provider</strong> District of Columbia<br />

Kim Randolph 000273 Yousefi Washington Clinic 3 Washington Circle, Suite G Washington DC 20037 General <strong>Provider</strong> District of Columbia<br />

Palizi Alireza 000273 Yousefi Washington Clinic 3 Washington Circle, Suite G Washington DC 20037 General <strong>Provider</strong> District of Columbia<br />

Yousefi Mehdi 000273 Yousefi Washington Clinic 3 Washington Circle, Suite G Washington DC 20037 General <strong>Provider</strong> District of Columbia<br />

Choudhri Sobia 033836 American <strong>Dental</strong> Care of Dover LLC 65 North DuPont Hwy Dover DE 19901 General <strong>Provider</strong> Kent<br />

Fortin Christopher 033836 American <strong>Dental</strong> Care of Dover LLC 65 North DuPont Hwy Dover DE 19901 General <strong>Provider</strong> Kent<br />

Medlin Tawana 033836 American <strong>Dental</strong> Care of Dover LLC 65 North DuPont Hwy Dover DE 19901 General <strong>Provider</strong> Kent<br />

Patel Amit 033836 American <strong>Dental</strong> Care of Dover LLC 65 North DuPont Hwy Dover DE 19901 General <strong>Provider</strong> Kent<br />

Patel Prafulchandra 033836 American <strong>Dental</strong> Care of Dover LLC 65 North DuPont Hwy Dover DE 19901 General <strong>Provider</strong> Kent<br />

Russo John 033836 American <strong>Dental</strong> Care of Dover LLC 65 North DuPont Hwy Dover DE 19901 General <strong>Provider</strong> Kent<br />

Russo Nicholas 033836 American <strong>Dental</strong> Care of Dover LLC 65 North DuPont Hwy Dover DE 19901 General <strong>Provider</strong> Kent<br />

Veith Charles 001496 Charles J Veith DMD PA MS 748 S. New Street Dover DE 19901 Orthodontist Kent<br />

* Fay Daniel 033837 Arthur W Henry DDS PA 748 S. New Street Dover DE 19904 General <strong>Provider</strong> Kent<br />

* Henry Arthur 033837 Arthur W Henry DDS PA 748 S. New Street Dover DE 19904 General <strong>Provider</strong> Kent<br />

Pancko Franklin 001569 Dover Oral and Maxillofacial Surgery 712 S. Governors Avenue Dover DE 19904 Oral Surgeon Kent<br />

Pillsbury James 079087 James S Pillsbury DDS 125 Greentree Dr, Suite 2 Dover DE 19904 General <strong>Provider</strong> Kent<br />

Fagioletti Lisa 061387 Lisa A Fagioletti DMD LLC 25 W Commerce St Smyrna DE 19977 General <strong>Provider</strong> Kent<br />

Cook Jeffrey 001466 Jeffrey L Cook DMD PA 16 Peddlers Village Christiana DE 19702 General <strong>Provider</strong> New Castle<br />

Cook G Leigh 001465 Cook Family Dentistry LLC 12 Pennington Street, Suite 300 Middletown DE 19709 General <strong>Provider</strong> New Castle<br />

Cook Megan 001465 Cook Family Dentistry LLC 12 Pennington Street, Suite 300 Middletown DE 19709 General <strong>Provider</strong> New Castle<br />

Recktenwald William 001899 Christiana <strong>Dental</strong> Center 330 Christiana Medical Center Newark DE 19702 General <strong>Provider</strong> New Castle<br />

* Duffy Michael 002860 Park Place <strong>Dental</strong> 210 West Park Place Newark DE 19711 General <strong>Provider</strong> New Castle<br />

* Kuipers Edwin 002860 Park Place <strong>Dental</strong> 210 West Park Place Newark DE 19711 General <strong>Provider</strong> New Castle<br />

* Russo Nicholas 002860 Park Place <strong>Dental</strong> 210 West Park Place Newark DE 19711 General <strong>Provider</strong> New Castle<br />

D'Amico, III Eugene 001526 Eugene M. D'Amico, III, D.D.S. 4735 Ogletown-Stanton Road, Suite 1115 Newark DE 19713 Oral Surgeon New Castle<br />

Le Hung 050875 Premier Dentistry of Christiana 4745 Ogletown-Stanton Rd, Suite 110 Newark DE 19713 General <strong>Provider</strong> New Castle<br />

Fink Fred 002855 Fred S. Fink, D.D.S. 3518 Silverside Rd, 23 The Commons Wilmington DE 19801 Orthodontist New Castle<br />

* Bayley Amanda 001474 Progressive <strong>Dental</strong> Arts 217 W. Ninth Street Wilmington DE 19801 General <strong>Provider</strong> New Castle<br />

* Nguyen Alan 001474 Progressive <strong>Dental</strong> Arts 217 W. Ninth Street Wilmington DE 19801 General <strong>Provider</strong> New Castle<br />

* Wu Lavinia 001474 Progressive <strong>Dental</strong> Arts 217 W. Ninth Street Wilmington DE 19801 General <strong>Provider</strong> New Castle<br />

* Hertzfeld Edward 001467 E.J. Hertzfeld, D.D.S., P.A. 1900 Washington Street Wilmington DE 19802 General <strong>Provider</strong> New Castle<br />

* Duffy Michael 001455 Foulk Road <strong>Dental</strong> 300 Foulk Road Wilmington DE 19803 General <strong>Provider</strong> New Castle<br />

* Kuipers Edwin 001455 Foulk Road <strong>Dental</strong> 300 Foulk Road Wilmington DE 19803 General <strong>Provider</strong> New Castle<br />

* Russo John 001455 Foulk Road <strong>Dental</strong> 300 Foulk Road Wilmington DE 19803 General <strong>Provider</strong> New Castle<br />

* Indicates dentist that is accepting current patients only.<br />

All <strong>Select</strong> <strong>Plan</strong> Dentists Page 1<br />

1 Same as a DHMO with fixed member copayments, no annual maximum dollar limits, no waiting periods, no deductibles, no pre-authorization paperwork or pre-treatment estimates and no<br />

claim forms or proof of loss (except in the case of out-of-area emergencies). Member must enroll with a General Dentist. Fac ID is used to indicate which facility a member chooses.


SELECT PLAN 1 DENTIST DIRECTORY<br />

Dentists listed are under contract as of 10/1/12<br />

Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />

* Russo Nicholas 001455 Foulk Road <strong>Dental</strong> 300 Foulk Road Wilmington DE 19803 General <strong>Provider</strong> New Castle<br />

Klassman Bradford 001566 Delaware Periodontics 1110 N. Bancroft Parkway Wilmington DE 19805 Periodontist New Castle<br />

Baker Elizabeth 002476 Westside Health 1802 W Fourth St Wilmington DE 19805 General <strong>Provider</strong> New Castle<br />

Kubasko MaryClare 002476 Westside Health 1802 W Fourth St Wilmington DE 19805 General <strong>Provider</strong> New Castle<br />

Swiatowicz Andrew 002476 Westside Health 1802 W Fourth St Wilmington DE 19805 General <strong>Provider</strong> New Castle<br />

Nguyen Keith 001510 Aesthetic & Special Care Associates PA 2323 Pennsylvania Avenue Wilmington DE 19806 General <strong>Provider</strong> New Castle<br />

Veith Charles 001493 Charles J Veith DMD PA MS 2300 Pennsylvania Avenue Wilmington DE 19806 Orthodontist New Castle<br />

* Sweeney, III Patrick 002753 Healthy Smiles of Delaware, P.A. 1700 Shall Cross Ave., Suite 2 Wilmington DE 19806 General <strong>Provider</strong> New Castle<br />

* Casalena Herbert 001463 Herbert T. Casalena, D.D.S., P.A. 2300 Pennsylvania Avenue, 6th floor Wilmington DE 19806 General <strong>Provider</strong> New Castle<br />

* Hounsell Jill 001463 Herbert T. Casalena, D.D.S., P.A. 2300 Pennsylvania Avenue, 6th floor Wilmington DE 19806 General <strong>Provider</strong> New Castle<br />

Kim Jung 001573 Kreshtool & Kim Endodontics PA 1815 West 13th Street, Suite 7 Wilmington DE 19806 Endodontist New Castle<br />

Kreshtool Daniel 001573 Kreshtool & Kim Endodontics PA 1815 West 13th Street, Suite 7 Wilmington DE 19806 Endodontist New Castle<br />

* Rybinski John 001460 John F. Rybinski, D.D.S. 2601 Annand Drive, Suite 6 Wilmington DE 19808 General <strong>Provider</strong> New Castle<br />

Elkington I 033877 Seaford <strong>Dental</strong> Associates 218 Pennsylvania Ave Seaford DE 19973 General <strong>Provider</strong> Sussex<br />

* Laparle Frank 000454 Frank A. Laparle, D.D.S. 500 Memorial Ave., #401 Cumberland MD 21502 General <strong>Provider</strong> Allegany<br />

* Brodell Lynne 000429 Lynne S. Brodell, D.D.S. 12600 Winchester Rd. #103 LaVale MD 21502 General <strong>Provider</strong> Allegany<br />

Labbe Stephen 000608 Stewart & Labbe, D.D.S., P.A. 101 Ridgely Ave., Suite 21 Annapolis MD 21401 Orthodontist Anne Arundel<br />

Stewart Lamon 000608 Stewart & Labbe, D.D.S., P.A. 101 Ridgely Ave., Suite 21 Annapolis MD 21401 Orthodontist Anne Arundel<br />

Hlousek Lubor 079093 Walzer Sullivan and Hlousek PA 101 Ridgely Avenue, Suite 21 Annapolis MD 21401 Oral Surgeon Anne Arundel<br />

Jones Kurt 079093 Walzer Sullivan and Hlousek PA 101 Ridgely Avenue, Suite 21 Annapolis MD 21401 Oral Surgeon Anne Arundel<br />

Sullivan Cornelius 079093 Walzer Sullivan and Hlousek PA 101 Ridgely Avenue, Suite 21 Annapolis MD 21401 Oral Surgeon Anne Arundel<br />

Walzer Clifford 079093 Walzer Sullivan and Hlousek PA 101 Ridgely Avenue, Suite 21 Annapolis MD 21401 Oral Surgeon Anne Arundel<br />

Granek Warren 050916 Warren Granek DDS 1410 Forest Dr, Suite 29 Annapolis MD 21403 Orthodontist Anne Arundel<br />

Hlousek Lubor 000593 Walzer Sullivan and Hlousek PA 275 West St, Suite 100 Annapolis MD 21404 Oral Surgeon Anne Arundel<br />

Jones Kurt 000593 Walzer Sullivan and Hlousek PA 275 West St, Suite 100 Annapolis MD 21404 Oral Surgeon Anne Arundel<br />

Sullivan Cornelius 000593 Walzer Sullivan and Hlousek PA 275 West St, Suite 100 Annapolis MD 21404 Oral Surgeon Anne Arundel<br />

Walzer Clifford 000593 Walzer Sullivan and Hlousek PA 275 West St, Suite 100 Annapolis MD 21404 Oral Surgeon Anne Arundel<br />

Heller Alan 004336 Alan R Heller DDS Ms 2200 Defense Highway, Suite 208 Crofton MD 21114 Orthodontist Anne Arundel<br />

Batrouni Ziad 051116 Maryland Oral Surgery Associates 1667 Crofton Centre, Suite 7A Crofton MD 21114 Oral Surgeon Anne Arundel<br />

Cohen Lisa 051116 Maryland Oral Surgery Associates 1667 Crofton Centre, Suite 7A Crofton MD 21114 Oral Surgeon Anne Arundel<br />

Griffith Miari-Ann 051116 Maryland Oral Surgery Associates 1667 Crofton Centre, Suite 7A Crofton MD 21114 Oral Surgeon Anne Arundel<br />

Kashyap Anil 051116 Maryland Oral Surgery Associates 1667 Crofton Centre, Suite 7A Crofton MD 21114 Oral Surgeon Anne Arundel<br />

Patel Chirag 051116 Maryland Oral Surgery Associates 1667 Crofton Centre, Suite 7A Crofton MD 21114 Oral Surgeon Anne Arundel<br />

Robinson Brian 051116 Maryland Oral Surgery Associates 1667 Crofton Centre, Suite 7A Crofton MD 21114 Oral Surgeon Anne Arundel<br />

Stark Mitchell 051116 Maryland Oral Surgery Associates 1667 Crofton Centre, Suite 7A Crofton MD 21114 Oral Surgeon Anne Arundel<br />

Trinh Huy 051116 Maryland Oral Surgery Associates 1667 Crofton Centre, Suite 7A Crofton MD 21114 Oral Surgeon Anne Arundel<br />

Criscitiello Kevin 000479 Ulery <strong>Dental</strong> & Orthodontics 1286 MD Rt. 3 South, Suite 7 Crofton MD 21114 General <strong>Provider</strong> Anne Arundel<br />

DeMizio Peter 000479 Ulery <strong>Dental</strong> & Orthodontics 1286 MD Rt. 3 South, Suite 7 Crofton MD 21114 Oral Surgeon Anne Arundel<br />

Elrafei Mohamed 000479 Ulery <strong>Dental</strong> & Orthodontics 1286 MD Rt. 3 South, Suite 7 Crofton MD 21114 General <strong>Provider</strong> Anne Arundel<br />

Ganjavian Babak 000479 Ulery <strong>Dental</strong> & Orthodontics 1286 MD Rt. 3 South, Suite 7 Crofton MD 21114 General <strong>Provider</strong> Anne Arundel<br />

Gentile Michael 000479 Ulery <strong>Dental</strong> & Orthodontics 1286 MD Rt. 3 South, Suite 7 Crofton MD 21114 Oral Surgeon Anne Arundel<br />

Ghajarnia Katayoun 000479 Ulery <strong>Dental</strong> & Orthodontics 1286 MD Rt. 3 South, Suite 7 Crofton MD 21114 General <strong>Provider</strong> Anne Arundel<br />

Ghajarnia M. Reza 000479 Ulery <strong>Dental</strong> & Orthodontics 1286 MD Rt. 3 South, Suite 7 Crofton MD 21114 Orthodontist Anne Arundel<br />

Jun Sung 000479 Ulery <strong>Dental</strong> & Orthodontics 1286 MD Rt. 3 South, Suite 7 Crofton MD 21114 General <strong>Provider</strong> Anne Arundel<br />

Mankiewicz Ryan 000479 Ulery <strong>Dental</strong> & Orthodontics 1286 MD Rt. 3 South, Suite 7 Crofton MD 21114 General <strong>Provider</strong> Anne Arundel<br />

Masood Arif 000479 Ulery <strong>Dental</strong> & Orthodontics 1286 MD Rt. 3 South, Suite 7 Crofton MD 21114 General <strong>Provider</strong> Anne Arundel<br />

Steinberg Wayne 000479 Ulery <strong>Dental</strong> & Orthodontics 1286 MD Rt. 3 South, Suite 7 Crofton MD 21114 General <strong>Provider</strong> Anne Arundel<br />

Tchakarova Ludmila 000479 Ulery <strong>Dental</strong> & Orthodontics 1286 MD Rt. 3 South, Suite 7 Crofton MD 21114 General <strong>Provider</strong> Anne Arundel<br />

Ulery Scott 000479 Ulery <strong>Dental</strong> & Orthodontics 1286 MD Rt. 3 South, Suite 7 Crofton MD 21114 General <strong>Provider</strong> Anne Arundel<br />

Weiss Karl 000479 Ulery <strong>Dental</strong> & Orthodontics 1286 MD Rt. 3 South, Suite 7 Crofton MD 21114 Orthodontist Anne Arundel<br />

Wolf Christopher 000479 Ulery <strong>Dental</strong> & Orthodontics 1286 MD Rt. 3 South, Suite 7 Crofton MD 21114 General <strong>Provider</strong> Anne Arundel<br />

Granek Warren 050917 Warren Granek DDS 3143 Solomns Island Rd Edgewater MD 21037 Orthodontist Anne Arundel<br />

Muko Deep 002216 Gambrills Family Dentistry 959 Annapolis Road Gambrills MD 21054 General <strong>Provider</strong> Anne Arundel<br />

Mekouar Hicham 051010 Gambrills Orthodontics 331 Gambrills Rd, Suite 7 Gambrills MD 21054 Orthodontist Anne Arundel<br />

Garfinkel Allan 000590 Allan V. Garfinkle, D.D.S. 300 Hospital Drive #237 Glen Burnie MD 21061 Oral Surgeon Anne Arundel<br />

Goldman Stephen 037568 Drs. Goldman and Packman 7600 Ritchie Hwy Glen Burnie MD 21061 Periodontist Anne Arundel<br />

Anyadike Anthony 037653 Greenway Orthodontics, LLC 30 Greenway St. NW, Suite 4 Glen Burnie MD 21061 Orthodontist Anne Arundel<br />

Packman Harold 000760 Harold Packman, D.M.D., PA 7600 Ritchie Hwy. Glen Burnie MD 21061 Periodontist Anne Arundel<br />

Exposito Jacques 017299 Jacques P Exposito DDS 1404 Crain Highway South, Suite 110 Glen Burnie MD 21061 General <strong>Provider</strong> Anne Arundel<br />

Abrahams Heather 002337 Orthodontic Associates 7954 Balt-Annapolis Blvd. 2 C Glen Burnie MD 21061 Orthodontist Anne Arundel<br />

Miller Jeffrey 002337 Orthodontic Associates 7954 Balt-Annapolis Blvd. 2 C Glen Burnie MD 21061 Orthodontist Anne Arundel<br />

Williams David 002337 Orthodontic Associates 7954 Balt-Annapolis Blvd. 2 C Glen Burnie MD 21061 Orthodontist Anne Arundel<br />

Baliga Narayani 097167 PDOM Glen Burnie LLC 7704 Quarterfield Rd, Suite F Glen Burnie MD 21061 Pedodontist Anne Arundel<br />

Schapiro Howard 097167 PDOM Glen Burnie LLC 7704 Quarterfield Rd, Suite F Glen Burnie MD 21061 Pedodontist Anne Arundel<br />

Criscitiello Kevin 050372 Ulery <strong>Dental</strong> and Orthodontics 7067 Baltimore Annapolis Blvd Glen Burnie MD 21061 General <strong>Provider</strong> Anne Arundel<br />

DeMizio Peter 050372 Ulery <strong>Dental</strong> and Orthodontics 7067 Baltimore Annapolis Blvd Glen Burnie MD 21061 Oral Surgeon Anne Arundel<br />

* Indicates dentist that is accepting current patients only.<br />

All <strong>Select</strong> <strong>Plan</strong> Dentists Page 2<br />

1 Same as a DHMO with fixed member copayments, no annual maximum dollar limits, no waiting periods, no deductibles, no pre-authorization paperwork or pre-treatment estimates and no<br />

claim forms or proof of loss (except in the case of out-of-area emergencies). Member must enroll with a General Dentist. Fac ID is used to indicate which facility a member chooses.


SELECT PLAN 1 DENTIST DIRECTORY<br />

Dentists listed are under contract as of 10/1/12<br />

Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />

Elrafei Mohamed 050372 Ulery <strong>Dental</strong> and Orthodontics 7067 Baltimore Annapolis Blvd Glen Burnie MD 21061 General <strong>Provider</strong> Anne Arundel<br />

Ganjavian Babak 050372 Ulery <strong>Dental</strong> and Orthodontics 7067 Baltimore Annapolis Blvd Glen Burnie MD 21061 General <strong>Provider</strong> Anne Arundel<br />

Gentile Michael 050372 Ulery <strong>Dental</strong> and Orthodontics 7067 Baltimore Annapolis Blvd Glen Burnie MD 21061 Oral Surgeon Anne Arundel<br />

Ghajarnia Katayoun 050372 Ulery <strong>Dental</strong> and Orthodontics 7067 Baltimore Annapolis Blvd Glen Burnie MD 21061 General <strong>Provider</strong> Anne Arundel<br />

Ghajarnia M. Reza 050372 Ulery <strong>Dental</strong> and Orthodontics 7067 Baltimore Annapolis Blvd Glen Burnie MD 21061 Orthodontist Anne Arundel<br />

Jun Sung 050372 Ulery <strong>Dental</strong> and Orthodontics 7067 Baltimore Annapolis Blvd Glen Burnie MD 21061 General <strong>Provider</strong> Anne Arundel<br />

Mankiewicz Ryan 050372 Ulery <strong>Dental</strong> and Orthodontics 7067 Baltimore Annapolis Blvd Glen Burnie MD 21061 General <strong>Provider</strong> Anne Arundel<br />

Masood Arif 050372 Ulery <strong>Dental</strong> and Orthodontics 7067 Baltimore Annapolis Blvd Glen Burnie MD 21061 General <strong>Provider</strong> Anne Arundel<br />

Tchakarova Ludmila 050372 Ulery <strong>Dental</strong> and Orthodontics 7067 Baltimore Annapolis Blvd Glen Burnie MD 21061 General <strong>Provider</strong> Anne Arundel<br />

Ulery Scott 050372 Ulery <strong>Dental</strong> and Orthodontics 7067 Baltimore Annapolis Blvd Glen Burnie MD 21061 General <strong>Provider</strong> Anne Arundel<br />

Weiss Karl 050372 Ulery <strong>Dental</strong> and Orthodontics 7067 Baltimore Annapolis Blvd Glen Burnie MD 21061 Orthodontist Anne Arundel<br />

Wolf Christopher 050372 Ulery <strong>Dental</strong> and Orthodontics 7067 Baltimore Annapolis Blvd Glen Burnie MD 21061 General <strong>Provider</strong> Anne Arundel<br />

Bonebreak David 069565 Chesapeake Orthodontics 7556 Teague Rd, Suite 106 Hanover MD 21076 Orthodontist Anne Arundel<br />

* Stephens George 000284 George M. Stephens, D.D.S. 3450 Ft. Meade Rd., Suite 211 Laurel MD 20724 General <strong>Provider</strong> Anne Arundel<br />

* Tehrani Saideh 000446 Saideh Tehrani, D.M.D. 3450 Fort Meade Rd. #202, Suite 202 Laurel MD 20724 General <strong>Provider</strong> Anne Arundel<br />

Sevilla Guevara Maria 068495 Childrens Dentistry at Odenton LLC 1215 Annapolis Rd, Suite 106 Odenton MD 21113 Pedodontist Anne Arundel<br />

Winnard Robert 050799 Robert G. Winnard, D.M.D. 1215 Annapolis Rd., Suite 207 Odenton MD 21113 Orthodontist Anne Arundel<br />

Clark Maxine 050731 Maryland Orthodontic Specialists 8028 Ritchie Hwy, Suite 202 Pasadena MD 21122 Orthodontist Anne Arundel<br />

Criscitiello Kevin 002011 Ulery <strong>Dental</strong> & Orthodontics 8055 Ritchie Hwy, Suite 102 Pasadena MD 21122 General <strong>Provider</strong> Anne Arundel<br />

DeMizio Peter 002011 Ulery <strong>Dental</strong> & Orthodontics 8055 Ritchie Hwy, Suite 102 Pasadena MD 21122 Oral Surgeon Anne Arundel<br />

Elrafei Mohamed 002011 Ulery <strong>Dental</strong> & Orthodontics 8055 Ritchie Hwy, Suite 102 Pasadena MD 21122 General <strong>Provider</strong> Anne Arundel<br />

Ganjavian Babak 002011 Ulery <strong>Dental</strong> & Orthodontics 8055 Ritchie Hwy, Suite 102 Pasadena MD 21122 General <strong>Provider</strong> Anne Arundel<br />

Gentile Michael 002011 Ulery <strong>Dental</strong> & Orthodontics 8055 Ritchie Hwy, Suite 102 Pasadena MD 21122 Oral Surgeon Anne Arundel<br />

Ghajarnia Katayoun 002011 Ulery <strong>Dental</strong> & Orthodontics 8055 Ritchie Hwy, Suite 102 Pasadena MD 21122 General <strong>Provider</strong> Anne Arundel<br />

Ghajarnia M. Reza 002011 Ulery <strong>Dental</strong> & Orthodontics 8055 Ritchie Hwy, Suite 102 Pasadena MD 21122 Orthodontist Anne Arundel<br />

Jun Sung 002011 Ulery <strong>Dental</strong> & Orthodontics 8055 Ritchie Hwy, Suite 102 Pasadena MD 21122 General <strong>Provider</strong> Anne Arundel<br />

Mankiewicz Ryan 002011 Ulery <strong>Dental</strong> & Orthodontics 8055 Ritchie Hwy, Suite 102 Pasadena MD 21122 General <strong>Provider</strong> Anne Arundel<br />

Masood Arif 002011 Ulery <strong>Dental</strong> & Orthodontics 8055 Ritchie Hwy, Suite 102 Pasadena MD 21122 General <strong>Provider</strong> Anne Arundel<br />

Steinberg Wayne 002011 Ulery <strong>Dental</strong> & Orthodontics 8055 Ritchie Hwy, Suite 102 Pasadena MD 21122 General <strong>Provider</strong> Anne Arundel<br />

Tchakarova Ludmila 002011 Ulery <strong>Dental</strong> & Orthodontics 8055 Ritchie Hwy, Suite 102 Pasadena MD 21122 General <strong>Provider</strong> Anne Arundel<br />

Ulery Scott 002011 Ulery <strong>Dental</strong> & Orthodontics 8055 Ritchie Hwy, Suite 102 Pasadena MD 21122 General <strong>Provider</strong> Anne Arundel<br />

Weiss Karl 002011 Ulery <strong>Dental</strong> & Orthodontics 8055 Ritchie Hwy, Suite 102 Pasadena MD 21122 Orthodontist Anne Arundel<br />

Wolf Christopher 002011 Ulery <strong>Dental</strong> & Orthodontics 8055 Ritchie Hwy, Suite 102 Pasadena MD 21122 General <strong>Provider</strong> Anne Arundel<br />

Hlousek Lubor 000594 Walzer Sullivan and Hlousek PA 8092 Edwin Raynor Blvd. # A Pasadena MD 21122 Oral Surgeon Anne Arundel<br />

Jones Kurt 000594 Walzer Sullivan and Hlousek PA 8092 Edwin Raynor Blvd. # A Pasadena MD 21122 Oral Surgeon Anne Arundel<br />

Sullivan Cornelius 000594 Walzer Sullivan and Hlousek PA 8092 Edwin Raynor Blvd. # A Pasadena MD 21122 Oral Surgeon Anne Arundel<br />

Walzer Clifford 000594 Walzer Sullivan and Hlousek PA 8092 Edwin Raynor Blvd. # A Pasadena MD 21122 Oral Surgeon Anne Arundel<br />

Garden Richard 000689 Richard B. Garden, D.D.S. 555 Benfield Road Severna Park MD 21146 Oral Surgeon Anne Arundel<br />

* Bae Hyung Jin 061388 <strong>Dental</strong> One Associates Security Blvd LLC 6666 Security Blvd Baltimore MD 21207 Pedodontist Baltimore<br />

* Huynh Thuylinh 061388 <strong>Dental</strong> One Associates Security Blvd LLC 6666 Security Blvd Baltimore MD 21207 Orthodontist Baltimore<br />

* Patel Yash 061388 <strong>Dental</strong> One Associates Security Blvd LLC 6666 Security Blvd Baltimore MD 21207 General <strong>Provider</strong> Baltimore<br />

* Seyedsalari Leila 061388 <strong>Dental</strong> One Associates Security Blvd LLC 6666 Security Blvd Baltimore MD 21207 General <strong>Provider</strong> Baltimore<br />

* Thompson Mellanie 061388 <strong>Dental</strong> One Associates Security Blvd LLC 6666 Security Blvd Baltimore MD 21207 General <strong>Provider</strong> Baltimore<br />

Dyson, Jr. Joseph 000163 Joseph L. Dyson, Jr., D.D.S. 4901 Liberty Heights Ave. Baltimore MD 21207 General <strong>Provider</strong> Baltimore<br />

Fried Daniel 000582 Daniel I. Fried, D.M.D. 3635 Old Court Rd. #501 Baltimore MD 21208 Oral Surgeon Baltimore<br />

Gordon James 000850 Drs. Branoff & Kress PA 3635 Old Court Rd., Suite 505 Baltimore MD 21208 Orthodontist Baltimore<br />

Greenberg Ned 011212 Ned S Greenberg DDS PA 2100 Eastern Boulevard Baltimore MD 21220 General <strong>Provider</strong> Baltimore<br />

Livingston Herbert 078261 Ned S Greenberg DDS PA Specialist 2100 Eastern Boulevard Baltimore MD 21220 Periodontist Baltimore<br />

Zia Amir 002690 Lansdowne Family <strong>Dental</strong> 2717 Hammonds Ferry Rd. Baltimore MD 21227 General <strong>Provider</strong> Baltimore<br />

Ramamurthy S 000271 S.V. Ramamurthy, D.D.S. 8713 Harford Rd. Baltimore MD 21234 General <strong>Provider</strong> Baltimore<br />

Romeo Frank 000644 Frank J. Romeo, D.D.S. 7544 Belair Road Baltimore MD 21236 Oral Surgeon Baltimore<br />

Fechter Maury 000291 Maury J. Fechter, D.D.S. 8817 Belair Road, Suite 105 Baltimore MD 21236 General <strong>Provider</strong> Baltimore<br />

Abrahams Heather 003409 Orthodontic Associates 7544 Belair Road, 2Nd Floor Baltimore MD 21236 Orthodontist Baltimore<br />

Miller Jeffrey 003409 Orthodontic Associates 7544 Belair Road, 2Nd Floor Baltimore MD 21236 Orthodontist Baltimore<br />

Williams David 003409 Orthodontic Associates 7544 Belair Road, 2Nd Floor Baltimore MD 21236 Orthodontist Baltimore<br />

Kodeck Robert 000356 Robert Kodeck, D.D.S. 7850 Rossville Blvd. Baltimore MD 21236 General <strong>Provider</strong> Baltimore<br />

Angamuthu Vijayalakshmi 017177 Convenient <strong>Dental</strong> 1726 North Rolling Road Baltimore MD 21244 General <strong>Provider</strong> Baltimore<br />

Yuille Bruce 000409 Bruce E.Yuille, D.D.S. 700 Geipe Road, Suite 270 Catonsville MD 21228 General <strong>Provider</strong> Baltimore<br />

Clark Maxine 050741 Maryland Orthodontic Specialists 2 E Rolling Crossroads Catonsville MD 21228 Orthodontist Baltimore<br />

Abrahams Heather 002327 Orthodontic Associates 606 Frederick Road, 2nd Floor Catonsville MD 21228 Orthodontist Baltimore<br />

Miller Jeffrey 002327 Orthodontic Associates 606 Frederick Road, 2nd Floor Catonsville MD 21228 Orthodontist Baltimore<br />

Williams David 002327 Orthodontic Associates 606 Frederick Road, 2nd Floor Catonsville MD 21228 Orthodontist Baltimore<br />

Dahne Marlene 000396 The <strong>Dental</strong> Care Center 4 East Rolling Crossroads, Suite 104 Catonsville MD 21228 General <strong>Provider</strong> Baltimore<br />

Tzomides Thomas 051041 Thomas G Tzomides DDS LLC 30 Middle River Rd Middle River MD 21220 General <strong>Provider</strong> Baltimore<br />

Berman Barry 000579 Barry R. Berman , D.D.S. 110 Painters Mill Road Owings Mills MD 21117 Oral Surgeon Baltimore<br />

Moore Brian 051086 Brian C Moore DMD PC 10085 Red Run Blvd, Suite 407 Owings Mills MD 21117 General <strong>Provider</strong> Baltimore<br />

* Indicates dentist that is accepting current patients only.<br />

All <strong>Select</strong> <strong>Plan</strong> Dentists Page 3<br />

1 Same as a DHMO with fixed member copayments, no annual maximum dollar limits, no waiting periods, no deductibles, no pre-authorization paperwork or pre-treatment estimates and no<br />

claim forms or proof of loss (except in the case of out-of-area emergencies). Member must enroll with a General Dentist. Fac ID is used to indicate which facility a member chooses.


SELECT PLAN 1 DENTIST DIRECTORY<br />

Dentists listed are under contract as of 10/1/12<br />

Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />

* Miller Cynthia 000562 Cynthia F. Miller, D.D.S. 6 Park Center Court, Suite 107 Owings Mills MD 21117 General <strong>Provider</strong> Baltimore<br />

Millman Jules 000302 Jules Millman, D.D.S. 10353 Reisterstown Rd. Owings Mills MD 21117 General <strong>Provider</strong> Baltimore<br />

Abrahams Heather 002338 Orthodontic Associates 20 Crossroads Drive Ste. 116 Owings Mills MD 21117 Orthodontist Baltimore<br />

Miller Jeffrey 002338 Orthodontic Associates 20 Crossroads Drive Ste. 116 Owings Mills MD 21117 Orthodontist Baltimore<br />

Williams David 002338 Orthodontic Associates 20 Crossroads Drive Ste. 116 Owings Mills MD 21117 Orthodontist Baltimore<br />

Belt Ogden 000767 Ogden M. Belt, D.D.S. The Commerce Center, 1777 Reisterstown Rd., #220 Pikesville MD 21208 General <strong>Provider</strong> Baltimore<br />

Snell, II Franklin 037724 Esquire Family <strong>Dental</strong> Care, LLC 3673 Offutt Rd Randallstown MD 21133 General <strong>Provider</strong> Baltimore<br />

Freundlich Howard 009719 Pleet And Freundlich DDS Pa 5310 Old Court Road, 202 Randallstown MD 21133 General <strong>Provider</strong> Baltimore<br />

Markow Steven 009719 Pleet And Freundlich DDS Pa 5310 Old Court Road, 202 Randallstown MD 21133 General <strong>Provider</strong> Baltimore<br />

Garfinkel Allan 000589 Allan V. Garfinkel, D.D.S. 100 Owings Court #16 Reisterstown MD 21136 Oral Surgeon Baltimore<br />

Gordon James 000851 Drs. Branoff & Kress PA 100 Owings Court, Suite 16 Reisterstown MD 21136 Orthodontist Baltimore<br />

Fields David 009728 David A Fields Jr DDS Pa 2300 York Road, Suite 204 Timonium MD 21093 Orthodontist Baltimore<br />

McCausland, III Charles 051098 Charles P McCausland III DDS 312 W Chesapeake Ave Towson MD 21204 General <strong>Provider</strong> Baltimore<br />

Rosengarden Ivan 000529 Joppa Partners 219 W. Joppa Rd. Towson MD 21204 General <strong>Provider</strong> Baltimore<br />

Sehdev Inderjit 000529 Joppa Partners 219 W. Joppa Rd. Towson MD 21204 General <strong>Provider</strong> Baltimore<br />

Lucas Peter 001773 Brenda K. Richardson, D.D.S. 515 E. Joppa Rd., Ste. 106 Towson MD 21286 Endodontist Baltimore<br />

Richardson Brenda 001773 Brenda K. Richardson, D.D.S. 515 E. Joppa Rd., Ste. 106 Towson MD 21286 Endodontist Baltimore<br />

* Mastella Stephen 000294 Stephen B. Mastella, D.M.D. & Assoc, PA 1030 N Charles St, Suite 302 Baltimore MD 21201 General <strong>Provider</strong> Baltimore City<br />

* Narun Martin 000294 Stephen B. Mastella, D.M.D. & Assoc, PA 1030 N Charles St, Suite 302 Baltimore MD 21201 Periodontist Baltimore City<br />

* Stockmann-Morte Karin 000294 Stephen B. Mastella, D.M.D. & Assoc, PA 1030 N Charles St, Suite 302 Baltimore MD 21201 Periodontist Baltimore City<br />

Fechter Maury 000292 Maury J. Fechter, D.D.S. 700 North Linwood Ave. Baltimore MD 21205 General <strong>Provider</strong> Baltimore City<br />

Kromah Margaret 037648 Margaret Kromah, D.D.S. 4403 Moravia Rd., Suite 2 Baltimore MD 21206 General <strong>Provider</strong> Baltimore City<br />

Fechter Maury 037616 Maury J. Fechter, D.D.S. 6305 Bel Air Rd. Baltimore MD 21206 General <strong>Provider</strong> Baltimore City<br />

Colvin Ernest 068517 Ernest J Colvin & Associates 5808 York Rd, Suite A Baltimore MD 21212 General <strong>Provider</strong> Baltimore City<br />

Goodman Robert 025390 Robert A Goodman DDS 6301 North Charles Street, Suite 3 Baltimore MD 21212 General <strong>Provider</strong> Baltimore City<br />

Hickey Stephen 069564 Stephen J Hickey DMD 5010 Harford Rd Baltimore MD 21214 General <strong>Provider</strong> Baltimore City<br />

Colvin Ernest 068516 Ernest J Colvin & Associates 4413 1/2 Park Heights Ave Baltimore MD 21215 General <strong>Provider</strong> Baltimore City<br />

Butler Stewart 037575 Park West Health Systems 3319 W. Belvedere Ave. Baltimore MD 21215 General <strong>Provider</strong> Baltimore City<br />

Dunstan Hyacinth 037575 Park West Health Systems 3319 W. Belvedere Ave. Baltimore MD 21215 General <strong>Provider</strong> Baltimore City<br />

Einbinder Elliot 037575 Park West Health Systems 3319 W. Belvedere Ave. Baltimore MD 21215 General <strong>Provider</strong> Baltimore City<br />

Langermann Rena 001207 Rena K. Langermann, DDS 6606 Cross Country Blvd. Baltimore MD 21215 General <strong>Provider</strong> Baltimore City<br />

Desbordes Fabian 018764 Fabian F Desbordes DDS 2300 Garrison Boulevard, Suite 250 Baltimore MD 21216 General <strong>Provider</strong> Baltimore City<br />

Bell Lawrence 001382 Bell & Associates 3326 Auchentoroly Terrace Baltimore MD 21217 General <strong>Provider</strong> Baltimore City<br />

Dyson, Jr. Joseph 000164 Joseph L. Dyson, Jr., D.D.S. 1721 Pennsylvania Ave. Baltimore MD 21217 General <strong>Provider</strong> Baltimore City<br />

Glascoe Alison 061312 David A Camorali DDS Specialists 1010 S North Pointe Blvd Baltimore MD 21224 Periodontist Baltimore City<br />

Mitcherling John 001547 Mitcherling Mitcherling & Johnson PA 1107 N Point Blvd, Suite 204 Baltimore MD 21224 Oral Surgeon Baltimore City<br />

Mitcherling William 001547 Mitcherling Mitcherling & Johnson PA 1107 N Point Blvd, Suite 204 Baltimore MD 21224 Oral Surgeon Baltimore City<br />

Reyes Vivencio 000368 Vivencio R. Reyes, D.D.S., P.A. 402 South Highland Ave. Baltimore MD 21224 General <strong>Provider</strong> Baltimore City<br />

Freed Sheldon 051106 Good Samaritan <strong>Dental</strong> & Surgical Associates 5601 Loch Raven Blvd, PO Box 209 Baltimore MD 21239 General <strong>Provider</strong> Baltimore City<br />

Krishnan Radha 002804 Calvert Orthodontics 294 Merrimac Court Prince Frederick MD 20678 Orthodontist Calvert<br />

Niemann Ralph 051107 Ralph W Niemann DDS 272 Merrimac Ct Prince Frederick MD 20678 Endodontist Calvert<br />

Dowling Thomas 001105 Thomas F. Dowling, DDS 310 Merrimac Court Prince Frederick MD 20678 Orthodontist Calvert<br />

Gordon James 037543 Drs. Branoff & Kress PA 1425 Liberty Rd., #16 Eldersburg MD 21784 Orthodontist Carroll<br />

Addicks Earl 068507 Earl M Addicks DDS PC 2025 Suffolk Rd, Suite 12 Finksburg MD 21048 General <strong>Provider</strong> Carroll<br />

Fields David 050992 David A Fields DDS 511 Jermor Ln, Suite 101 Westminster MD 21157 Orthodontist Carroll<br />

Grillon George 000591 George L. Grillon, D.M.D. 250 Englar Road #4 Westminster MD 21157 Oral Surgeon Carroll<br />

Gham Deepali 070916 Delmarva Center for <strong>Dental</strong> Excellence 230 S Bridge St, Suite A Elkton MD 21921 General <strong>Provider</strong> Cecil<br />

Baliga Narayani 097166 PDOM Elkton LLC 103 Chesapeake Blvd, Suite E Elkton MD 21921 Pedodontist Cecil<br />

Davar Vidhima 097166 PDOM Elkton LLC 103 Chesapeake Blvd, Suite E Elkton MD 21921 Pedodontist Cecil<br />

Kim Christie 097166 PDOM Elkton LLC 103 Chesapeake Blvd, Suite E Elkton MD 21921 Pedodontist Cecil<br />

Schapiro Howard 097166 PDOM Elkton LLC 103 Chesapeake Blvd, Suite E Elkton MD 21921 Pedodontist Cecil<br />

Abbasian Vargha 002757 Vargha Abbasian, D.D.S., P.C. 1653 Elkton Rd. Elkton MD 21921 General <strong>Provider</strong> Cecil<br />

* Pasqualini Charles 000184 C.V. Pasqualini, Jr., D.M.D. 111 Howard Street Elkton MD 21922 General <strong>Provider</strong> Cecil<br />

* Hewitt Godfrey 000410 Metro <strong>Dental</strong> Center 6620 Crain Highway #204 La Plata MD 20646 General <strong>Provider</strong> Charles<br />

* John Orville 000410 Metro <strong>Dental</strong> Center 6620 Crain Highway #204 La Plata MD 20646 General <strong>Provider</strong> Charles<br />

* Morgan-Belcher Althea 000410 Metro <strong>Dental</strong> Center 6620 Crain Highway #204 La Plata MD 20646 General <strong>Provider</strong> Charles<br />

King Michael 026658 King Oral Surgery Group PC 11885 Holly Lane, Suite 2 Waldorf MD 20601 Oral Surgeon Charles<br />

Hector Ricardo 072092 Aegis <strong>Dental</strong> Group LLC 363 Smallwood Dr Waldorf MD 20602 General <strong>Provider</strong> Charles<br />

Doumit Antoine 061330 Antoine Doumit DMD CAGS PC 603 Post Office Rd, Suite 109 Waldorf MD 20602 Orthodontist Charles<br />

Fitchett Glander 000434 Post Office Lake <strong>Dental</strong> Assoc. 603 Post Office Road, Suite 208 Waldorf MD 20602 General <strong>Provider</strong> Charles<br />

Hood, III James 000434 Post Office Lake <strong>Dental</strong> Assoc. 603 Post Office Road, Suite 208 Waldorf MD 20602 General <strong>Provider</strong> Charles<br />

Wiltshire Cathy 000434 Post Office Lake <strong>Dental</strong> Assoc. 603 Post Office Road, Suite 208 Waldorf MD 20602 Orthodontist Charles<br />

Maloney Joseph 002324 Tuan D Pham DMD & Joseph A Maloney DDS LLC 3450 Old Washington Road, Suite 204 Waldorf MD 20602 General <strong>Provider</strong> Charles<br />

Pham Tuan 002324 Tuan D Pham DMD & Joseph A Maloney DDS LLC 3450 Old Washington Road, Suite 204 Waldorf MD 20602 General <strong>Provider</strong> Charles<br />

Niemann Ralph 051108 Ralph W Niemann DDS 3050 Crain Hwy, Suite 303 Waldorf MD 20604 Endodontist Charles<br />

Purohit Atulkumar 047035 Atul Purohit DDS 801 Toll House Avenue, Building I Frederick MD 21701 General <strong>Provider</strong> Frederick<br />

* Indicates dentist that is accepting current patients only.<br />

All <strong>Select</strong> <strong>Plan</strong> Dentists Page 4<br />

1 Same as a DHMO with fixed member copayments, no annual maximum dollar limits, no waiting periods, no deductibles, no pre-authorization paperwork or pre-treatment estimates and no<br />

claim forms or proof of loss (except in the case of out-of-area emergencies). Member must enroll with a General Dentist. Fac ID is used to indicate which facility a member chooses.


SELECT PLAN 1 DENTIST DIRECTORY<br />

Dentists listed are under contract as of 10/1/12<br />

Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />

Romanow Gregory 002269 Goldblatt, Sweeney & Wise, D.D.S., MS 504 West Patrick Street, Suite D Frederick MD 21701 Oral Surgeon Frederick<br />

Sweeney Albert 002269 Goldblatt, Sweeney & Wise, D.D.S., MS 504 West Patrick Street, Suite D Frederick MD 21701 Oral Surgeon Frederick<br />

Wise John 002269 Goldblatt, Sweeney & Wise, D.D.S., MS 504 West Patrick Street, Suite D Frederick MD 21701 Oral Surgeon Frederick<br />

Pierce Kurt 002405 Kurt A. Pierce, D.D.S., M.S. 604 Solarex Ct., #209 Frederick MD 21701 Orthodontist Frederick<br />

Leon Lili 001167 Behnaz Yalda, D.D.S. 77 Thomas Johnson Dr., #D Frederick MD 21702 Periodontist Frederick<br />

Yalda Behnaz 001167 Behnaz Yalda, D.D.S. 77 Thomas Johnson Dr., #D Frederick MD 21702 Periodontist Frederick<br />

Alayssami Mazin 000193 Bright Now <strong>Dental</strong> 68 Thomas Johnson Dr., Suite B Frederick MD 21702 General <strong>Provider</strong> Frederick<br />

Byrd Richard 000193 Bright Now <strong>Dental</strong> 68 Thomas Johnson Dr., Suite B Frederick MD 21702 Orthodontist Frederick<br />

Hwang Gyu 000193 Bright Now <strong>Dental</strong> 68 Thomas Johnson Dr., Suite B Frederick MD 21702 General <strong>Provider</strong> Frederick<br />

Mazin Mark 000193 Bright Now <strong>Dental</strong> 68 Thomas Johnson Dr., Suite B Frederick MD 21702 General <strong>Provider</strong> Frederick<br />

Park Sang Hoon 000193 Bright Now <strong>Dental</strong> 68 Thomas Johnson Dr., Suite B Frederick MD 21702 Periodontist Frederick<br />

Pinetti John 000193 Bright Now <strong>Dental</strong> 68 Thomas Johnson Dr., Suite B Frederick MD 21702 General <strong>Provider</strong> Frederick<br />

Sargent Laurie 000193 Bright Now <strong>Dental</strong> 68 Thomas Johnson Dr., Suite B Frederick MD 21702 General <strong>Provider</strong> Frederick<br />

Saini Viney 050487 Clarksburg Orthodontics 182 Thomas Johnson Dr, Suite 104 Frederick MD 21702 Orthodontist Frederick<br />

Muko Deep 069530 Deep Muko DDS PA 198 Thomas Johnson Dr, Suite 18 Frederick MD 21702 General <strong>Provider</strong> Frederick<br />

Benitez Karen 037535 Dr. Sivakumar Pediatric <strong>Dental</strong> Center, LLC 57 A Thomas Johnson Drive, Suite 101 Frederick MD 21702 Pedodontist Frederick<br />

Kim Joonghyuk 037535 Dr. Sivakumar Pediatric <strong>Dental</strong> Center, LLC 57 A Thomas Johnson Drive, Suite 101 Frederick MD 21702 Pedodontist Frederick<br />

Lan Steve 037535 Dr. Sivakumar Pediatric <strong>Dental</strong> Center, LLC 57 A Thomas Johnson Drive, Suite 101 Frederick MD 21702 Pedodontist Frederick<br />

Sivakumar Savithri 037535 Dr. Sivakumar Pediatric <strong>Dental</strong> Center, LLC 57 A Thomas Johnson Drive, Suite 101 Frederick MD 21702 Pedodontist Frederick<br />

Sivakumar Thiruvanamalai 037535 Dr. Sivakumar Pediatric <strong>Dental</strong> Center, LLC 57 A Thomas Johnson Drive, Suite 101 Frederick MD 21702 Pedodontist Frederick<br />

Best Ronald 030666 Mid Maryland Oral And Maxillofacial Surgery 68 Thomas Johnson Drive, Suite A Frederick MD 21702 Oral Surgeon Frederick<br />

Kelley Richard 030666 Mid Maryland Oral And Maxillofacial Surgery 68 Thomas Johnson Drive, Suite A Frederick MD 21702 Oral Surgeon Frederick<br />

Tan Peter 030666 Mid Maryland Oral And Maxillofacial Surgery 68 Thomas Johnson Drive, Suite A Frederick MD 21702 Oral Surgeon Frederick<br />

Zwack William 030666 Mid Maryland Oral And Maxillofacial Surgery 68 Thomas Johnson Drive, Suite A Frederick MD 21702 Oral Surgeon Frederick<br />

Patel Suketu 037723 Alayssami <strong>Dental</strong>, P.C. Specialists 5726-B Buckeystown Pke Frederick MD 21704 Oral Surgeon Frederick<br />

Alayssami Mazin 037595 Bright Now <strong>Dental</strong> 5726 B. Buckeystown Pike Frederick MD 21704 General <strong>Provider</strong> Frederick<br />

Byrd Richard 037595 Bright Now <strong>Dental</strong> 5726 B. Buckeystown Pike Frederick MD 21704 Orthodontist Frederick<br />

Sargent Laurie 037595 Bright Now <strong>Dental</strong> 5726 B. Buckeystown Pike Frederick MD 21704 General <strong>Provider</strong> Frederick<br />

Thomasian Helen 037595 Bright Now <strong>Dental</strong> 5726 B. Buckeystown Pike Frederick MD 21704 General <strong>Provider</strong> Frederick<br />

Abousy Dawn 050727 Alpha <strong>Dental</strong> Excellence 122 N Philadelphia Blvd Aberdeen MD 21001 General <strong>Provider</strong> Harford<br />

Crocken Kerry 050727 Alpha <strong>Dental</strong> Excellence 122 N Philadelphia Blvd Aberdeen MD 21001 General <strong>Provider</strong> Harford<br />

Mahajan Priti 050727 Alpha <strong>Dental</strong> Excellence 122 N Philadelphia Blvd Aberdeen MD 21001 General <strong>Provider</strong> Harford<br />

Patel Arpan 050727 Alpha <strong>Dental</strong> Excellence 122 N Philadelphia Blvd Aberdeen MD 21001 General <strong>Provider</strong> Harford<br />

Kubiczek Iwona 002857 Iwona Kubiczek, D.D.S., P.C. 2021-B Emmorton Rd., Suite 216 Bel Air MD 21015 General <strong>Provider</strong> Harford<br />

Abrahams Heather 024754 Orthodontic Associates 2225 Old Emmorton Road, Suite 200 Bel Air MD 21015 Orthodontist Harford<br />

Miller Jeffrey 024754 Orthodontic Associates 2225 Old Emmorton Road, Suite 200 Bel Air MD 21015 Orthodontist Harford<br />

Williams David 024754 Orthodontic Associates 2225 Old Emmorton Road, Suite 200 Bel Air MD 21015 Orthodontist Harford<br />

Mazer Millard 079077 Thomas G Tzomides DDS LLC Specialists 2404 Pleasantville Rd Fallston MD 21047 Periodontist Harford<br />

Baliga Narayani 097165 PDOM Havre de Grace LLC 203 S Washington St Havre de Grace MD 21078 Pedodontist Harford<br />

Davar Vidhima 097165 PDOM Havre de Grace LLC 203 S Washington St Havre de Grace MD 21078 Pedodontist Harford<br />

Schapiro Howard 097165 PDOM Havre de Grace LLC 203 S Washington St Havre de Grace MD 21078 Pedodontist Harford<br />

Davanlou Azita 002723 Chartwell <strong>Dental</strong> Group 8180 Lark Brown Rd., Suite 202 Elkridge MD 21075 General <strong>Provider</strong> Howard<br />

* Skillman Robert 019200 Robert E Skillman, D.D.S., PA 5921 Old Washington Road Elkridge MD 21075 General <strong>Provider</strong> Howard<br />

Ajmal Nighat 022440 Ajmal <strong>Dental</strong> Care 10306 B Baltimore National Pik Ellicott City MD 21042 General <strong>Provider</strong> Howard<br />

Ajmal Riffat 022440 Ajmal <strong>Dental</strong> Care 10306 B Baltimore National Pik Ellicott City MD 21042 General <strong>Provider</strong> Howard<br />

Sedighian Ali 037537 Ali R. Sedighian, D.D.S., P.A. 9005 Chevrolet Dr., Suite 1 Ellicott City MD 21042 General <strong>Provider</strong> Howard<br />

Kim Philip 070463 Family Dentistry 9005 Chevrolet Dr, Suite 3 Ellicott City MD 21042 General <strong>Provider</strong> Howard<br />

Kim JoongSeo 051050 JoongSeo Kim DDS PC 10176 Baltimore National Pike, Suite 206 Ellicott City MD 21042 Prosthodontist Howard<br />

Clark Maxine 050678 Maryland Orthodontic Specialists 5094 Dorsey Hall Dr, Suite 204 Ellicott City MD 21042 Orthodontist Howard<br />

Abrahams Heather 002334 Orthodontic Associates 537-F Balt-Annapolis Blvd, P.O. Box 362 Ellicott City MD 21042 Orthodontist Howard<br />

Miller Jeffrey 002334 Orthodontic Associates 537-F Balt-Annapolis Blvd, P.O. Box 362 Ellicott City MD 21042 Orthodontist Howard<br />

Williams David 002334 Orthodontic Associates 537-F Balt-Annapolis Blvd, P.O. Box 362 Ellicott City MD 21042 Orthodontist Howard<br />

Winnard Robert 050800 Robert G. Winnard, D.M.D. 10030 Baltimore National Pike Ellicott City MD 21042 Orthodontist Howard<br />

Kang Sinha 069942 Sinha Kang DMD 5034 Dorsey Hall Dr, Suite 203 Ellicott City MD 21042 General <strong>Provider</strong> Howard<br />

Desai Chetna 002830 Chetna K. Desai, D.D.S., P.C. 3290 North Ridge Rd., Suite 180 Ellicott City MD 21043 General <strong>Provider</strong> Howard<br />

Esi Ejiro 078279 Esi Orthodontics 8170 Maple Lawn Blvd Fulton MD 20759 Orthodontist Howard<br />

Blucher Craig 069952 Dr Bluchers Family Dentistry 10741 Birmingham Way Woodstock MD 21163 General <strong>Provider</strong> Howard<br />

Milobsky Stanley 050769 Stanley A Milobsky DDS 13975 Connecticut Ave, Suite 318 Aspen Hill MD 20906 Endodontist Montgomery<br />

Heller Alan 002481 Alan R. Heller, D.D.S., M.S. 4405 East West Highway, #106 Bethesda MD 20814 Orthodontist Montgomery<br />

Ross David 037549 David S. Ross, D.D.S., PC 4949 Battery Lane Bethesda MD 20814 Oral Surgeon Montgomery<br />

Okun Martin 000546 Orthodontic Center of Maryland/Virginia 7201 Wisconsin Ave., Suite 370 Bethesda MD 20814 Orthodontist Montgomery<br />

DeMizio Peter 050850 Peter S DeMizio DDS <strong>Inc</strong> 4400 East West Hwy, Suite D Bethesda MD 20814 General <strong>Provider</strong> Montgomery<br />

DeMizio Peter 050850 Peter S DeMizio DDS <strong>Inc</strong> 4400 East West Hwy, Suite D Bethesda MD 20814 Oral Surgeon Montgomery<br />

* Cole Reginald 000460 Reginald W Cole, DDS 4400 East-West Hwy Suite F Bethesda MD 20814 General <strong>Provider</strong> Montgomery<br />

Sethi Shalini 079794 Roanne Wiczer DMD 8311 Wisconsin Ave, Suite B8 Bethesda MD 20814 Periodontist Montgomery<br />

Wiczer Roanne 001405 Roanne Wiczer DMD 8311 Wisconsin Ave, Suite B8 Bethesda MD 20814 General <strong>Provider</strong> Montgomery<br />

* Indicates dentist that is accepting current patients only.<br />

All <strong>Select</strong> <strong>Plan</strong> Dentists Page 5<br />

1 Same as a DHMO with fixed member copayments, no annual maximum dollar limits, no waiting periods, no deductibles, no pre-authorization paperwork or pre-treatment estimates and no<br />

claim forms or proof of loss (except in the case of out-of-area emergencies). Member must enroll with a General Dentist. Fac ID is used to indicate which facility a member chooses.


SELECT PLAN 1 DENTIST DIRECTORY<br />

Dentists listed are under contract as of 10/1/12<br />

Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />

Shroff Amisha 002367 Amisha N. Shroff, D.D.S., P.C. 10320 Westlake Drive, Suite 109 Bethesda MD 20817 General <strong>Provider</strong> Montgomery<br />

Grillon George 000610 George L. Grillon, D.M.D., P.C. 10215 Fernwood Rd, Ste. 510 Bethesda MD 20817 Oral Surgeon Montgomery<br />

Sheik Mon 037698 Mon F. Sheik, DMD 15234 Spencerville Ct, 101 Burtonsville MD 20866 General <strong>Provider</strong> Montgomery<br />

Saini Viney 002832 Viney P. Saini, D.D.S., M.S., LLC 23220 Brewers Tavern Way Clarksburg MD 20871 Orthodontist Montgomery<br />

Heller Alan 032681 Alan R Heller DDS 12116 Darnestown Road, Suite L 1 Darnestown MD 20878 Orthodontist Montgomery<br />

Malhmood Arnold 004589 Arnold I Malhmood DDS 474 North Frederick Avenue Gaithersburg MD 20877 General <strong>Provider</strong> Montgomery<br />

Chung Jay 050592 Chestnut Street Cosmetic Dentistry 101 Chestnut Street, Suite 130 Gaithersburg MD 20877 General <strong>Provider</strong> Montgomery<br />

Dubin Gerry 002432 Gerry Dubin, DMD, P.C. 9069 Shady Grove Ct. Gaithersburg MD 20877 General <strong>Provider</strong> Montgomery<br />

Elkhateeb Mohammad 002854 TLC Modern Dentistry 18220 Contour Rd. Gaithersburg MD 20877 General <strong>Provider</strong> Montgomery<br />

Le Chinh 002854 TLC Modern Dentistry 18220 Contour Rd. Gaithersburg MD 20877 General <strong>Provider</strong> Montgomery<br />

Nguyen Helen 002854 TLC Modern Dentistry 18220 Contour Rd. Gaithersburg MD 20877 General <strong>Provider</strong> Montgomery<br />

Nguyen Thy 002854 TLC Modern Dentistry 18220 Contour Rd. Gaithersburg MD 20877 General <strong>Provider</strong> Montgomery<br />

Tran Quang 002854 TLC Modern Dentistry 18220 Contour Rd. Gaithersburg MD 20877 General <strong>Provider</strong> Montgomery<br />

Lavine David 000537 Drs. Lavine and Decker 12113 Darnestown Rd Gaithersburg MD 20878 Orthodontist Montgomery<br />

Hassani Eftekhar 033884 Angamuthu & Associates DDS PA 4 Professional Dr., Suite 121 Gaithersburg MD 20879 General <strong>Provider</strong> Montgomery<br />

Jesson Vijayalakshmi 033884 Angamuthu & Associates DDS PA 4 Professional Dr., Suite 121 Gaithersburg MD 20879 General <strong>Provider</strong> Montgomery<br />

Tsintolas Chris 000544 Chris E. Tsintolas, D.D.S., M.S. 903 Russell Ave., #101 Gaithersburg MD 20879 Orthodontist Montgomery<br />

Romanow Gregory 000557 Goldblatt, Sweeney & Wise, D.D.S., MS 985 Russel Ave. Gaithersburg MD 20879 Oral Surgeon Montgomery<br />

Sweeney Albert 000557 Goldblatt, Sweeney & Wise, D.D.S., MS 985 Russel Ave. Gaithersburg MD 20879 Oral Surgeon Montgomery<br />

Wise John 000557 Goldblatt, Sweeney & Wise, D.D.S., MS 985 Russel Ave. Gaithersburg MD 20879 Oral Surgeon Montgomery<br />

Winnick Mark 000536 Mark B WinnickDDS PA 803 Russell Ave, #3A Gaithersburg MD 20879 Periodontist Montgomery<br />

Ghahreman Habib 000463 The <strong>Dental</strong> Suite 18218 Flower Hill Way Gaithersburg MD 20879 General <strong>Provider</strong> Montgomery<br />

Mirdamadi Behzad 000463 The <strong>Dental</strong> Suite 18218 Flower Hill Way Gaithersburg MD 20879 General <strong>Provider</strong> Montgomery<br />

Venigalla Lakshmi 004687 Family <strong>Dental</strong> Care 19729 Executive Park circle Germantown MD 20874 General <strong>Provider</strong> Montgomery<br />

Pierce Kurt 000605 Kurt A. Pierce, D.D.S., M.S. North Lake Medical Park, 19507 Doctors Drive Germantown MD 20874 Orthodontist Montgomery<br />

Tomona Natalia 037656 Natalia Tomona, D.D.S., PC 19735 Germantown Rd., Suite 140 Germantown MD 20874 Orthodontist Montgomery<br />

Liashek Peter 000551 Peter Liashek, Jr., D.D.S. 19717 Executive Pk. Circle Germantown MD 20874 Oral Surgeon Montgomery<br />

DeMizio Peter 037733 Peter S. DeMizio, DDS, <strong>Inc</strong>. 22 Executive Park Ct Germantown MD 20874 General <strong>Provider</strong> Montgomery<br />

DeMizio Peter 037733 Peter S. DeMizio, DDS, <strong>Inc</strong>. 22 Executive Park Ct Germantown MD 20874 Oral Surgeon Montgomery<br />

Lam Tony 002703 Seneca Park <strong>Dental</strong> 13529 Clopper Rd. Germantown MD 20874 General <strong>Provider</strong> Montgomery<br />

Nguyen Toan 050893 Smile Design <strong>Dental</strong> 19735 Germantown RD, Suite 170 Germantown MD 20874 General <strong>Provider</strong> Montgomery<br />

Barnett Robert 014880 Robert Barnett DDS 3720 Farragut Avenue, Suite 101 Kensington MD 20895 General <strong>Provider</strong> Montgomery<br />

Davis Gail 050796 Davis Endodontics 11908 Darnestown Rd., Suite F North Potomac MD 20878 Endodontist Montgomery<br />

Assatourian Karineh 050918 Premier <strong>Dental</strong> Clinic 17904 Georgia Ave, Suite 110 Olney MD 20832 General <strong>Provider</strong> Montgomery<br />

Dowling Thomas 000785 Thomas F. Dowling, D.D.S. 3403 Olandwood Court, Suite 201 Olney MD 20832 Orthodontist Montgomery<br />

Mahajan Dipty 097861 Key West <strong>Dental</strong> Care 9850 Keywest Ave, Suite 302 Rockville MD 20850 General <strong>Provider</strong> Montgomery<br />

Cohen Lisa 000566 Maryland Oral Surgery Associates 14955 Shady Grove Rd., Suite 330 Rockville MD 20850 Oral Surgeon Montgomery<br />

Griffith Miari-Ann 000566 Maryland Oral Surgery Associates 14955 Shady Grove Rd., Suite 330 Rockville MD 20850 Oral Surgeon Montgomery<br />

Kashyap Anil 000566 Maryland Oral Surgery Associates 14955 Shady Grove Rd., Suite 330 Rockville MD 20850 Oral Surgeon Montgomery<br />

Patel Chirag 000566 Maryland Oral Surgery Associates 14955 Shady Grove Rd., Suite 330 Rockville MD 20850 Oral Surgeon Montgomery<br />

Robinson Brian 000566 Maryland Oral Surgery Associates 14955 Shady Grove Rd., Suite 330 Rockville MD 20850 Oral Surgeon Montgomery<br />

Stark Mitchell 000566 Maryland Oral Surgery Associates 14955 Shady Grove Rd., Suite 330 Rockville MD 20850 Oral Surgeon Montgomery<br />

Trinh Huy 000566 Maryland Oral Surgery Associates 14955 Shady Grove Rd., Suite 330 Rockville MD 20850 Oral Surgeon Montgomery<br />

* Kodsi Nadim 037655 North Potomac Smiles LLC 15200 Shady Grove Road, Suite 408 Rockville MD 20850 General <strong>Provider</strong> Montgomery<br />

Chang Richard 000545 Richard Chang, D.M.D. 14955 Shady Grove Rd, 310 Rockville MD 20850 Orthodontist Montgomery<br />

Atam Asugman 033849 AA <strong>Dental</strong> Clinic 751 Rockville Pike, Suite 10A Rockville MD 20852 General <strong>Provider</strong> Montgomery<br />

* Parikh Chetan 002745 Chetan H. Parikh, D.M.D., PA 5808 Hubbard Dr. Rockville MD 20852 General <strong>Provider</strong> Montgomery<br />

Ha Derrick 050814 Happy <strong>Dental</strong> 4701 Randolph Road, Suite 210 Rockville MD 20852 General <strong>Provider</strong> Montgomery<br />

* Kim Hyosik 001041 Hysosik Kim, D.D.S. 785-A Rockville Pike Rockville MD 20852 General <strong>Provider</strong> Montgomery<br />

Kishter Steven 061397 Maryland Oral Surgery Associates of Bethesda LLC 11404 Old Georgetown Rd, Suite 104 Rockville MD 20852 Oral Surgeon Montgomery<br />

Patel Chirag 061397 Maryland Oral Surgery Associates of Bethesda LLC 11404 Old Georgetown Rd, Suite 104 Rockville MD 20852 Oral Surgeon Montgomery<br />

Chung Jay 000447 Montrose <strong>Dental</strong> Office 6232 Montrose Road Rockville MD 20852 General <strong>Provider</strong> Montgomery<br />

Singer Richard 000535 Richard P. Singer, D.D.S. 11300 Rockville Pike, #1210 Rockville MD 20852 Periodontist Montgomery<br />

Tofigh Hamid 037731 Rockville Family <strong>Dental</strong> Group 5806 Hubbard Dr Rockville MD 20852 General <strong>Provider</strong> Montgomery<br />

Esfandiari Sheila 002278 Tenley Orthodontics - Sheila Esfandiari, DDS, P.C. 50 West Edmonston Drive, #205 Rockville MD 20852 Orthodontist Montgomery<br />

Atashbar Hedyeh 001753 Hedyeh Atashbar, D.D.S. 11213 Lockwood Drive Silver Spring MD 20901 General <strong>Provider</strong> Montgomery<br />

Lam Wai 097859 Wai Lam DDS PA 11253 Lockwood Dr Silver Spring MD 20901 Orthodontist Montgomery<br />

Romanow Gregory 000598 Goldblatt,Sweeney & Wise, D.D.S., P.A. 10313 Georgia Ave # 102 Silver Spring MD 20902 Oral Surgeon Montgomery<br />

Sweeney Albert 000598 Goldblatt,Sweeney & Wise, D.D.S., P.A. 10313 Georgia Ave # 102 Silver Spring MD 20902 Oral Surgeon Montgomery<br />

Wise John 000598 Goldblatt,Sweeney & Wise, D.D.S., P.A. 10313 Georgia Ave # 102 Silver Spring MD 20902 Oral Surgeon Montgomery<br />

Potluri Sumesh 072098 Silver Spring Endodontics 10301 Georgia Ave, Suite 202 Silver Spring MD 20902 Endodontist Montgomery<br />

Nuh Asma 051014 Asma Nuh DDS PA 1016 Merrimac Dr Silver Spring MD 20903 General <strong>Provider</strong> Montgomery<br />

De Marco Lisa 000826 Drs DeMarco & Tilkin PA 11120 New Hampshire Ave., Suite 402 Silver Spring MD 20904 Orthodontist Montgomery<br />

Tilkin Nancy 000826 Drs DeMarco & Tilkin PA 11120 New Hampshire Ave., Suite 402 Silver Spring MD 20904 Orthodontist Montgomery<br />

Okun Martin 043711 Martin L Okun DDS 2415 Musgrove Road, Suite 301 Silver Spring MD 20904 Orthodontist Montgomery<br />

Batrouni Ziad 002627 Maryland Oral Surgery Associates, PA 11120 New Hampshire Ave., Suite 501 Silver Spring MD 20904 Oral Surgeon Montgomery<br />

* Indicates dentist that is accepting current patients only.<br />

All <strong>Select</strong> <strong>Plan</strong> Dentists Page 6<br />

1 Same as a DHMO with fixed member copayments, no annual maximum dollar limits, no waiting periods, no deductibles, no pre-authorization paperwork or pre-treatment estimates and no<br />

claim forms or proof of loss (except in the case of out-of-area emergencies). Member must enroll with a General Dentist. Fac ID is used to indicate which facility a member chooses.


SELECT PLAN 1 DENTIST DIRECTORY<br />

Dentists listed are under contract as of 10/1/12<br />

Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />

Cohen Lisa 002627 Maryland Oral Surgery Associates, PA 11120 New Hampshire Ave., Suite 501 Silver Spring MD 20904 Oral Surgeon Montgomery<br />

Griffith Miari-Ann 002627 Maryland Oral Surgery Associates, PA 11120 New Hampshire Ave., Suite 501 Silver Spring MD 20904 Oral Surgeon Montgomery<br />

Kashyap Anil 002627 Maryland Oral Surgery Associates, PA 11120 New Hampshire Ave., Suite 501 Silver Spring MD 20904 Oral Surgeon Montgomery<br />

Patel Chirag 002627 Maryland Oral Surgery Associates, PA 11120 New Hampshire Ave., Suite 501 Silver Spring MD 20904 Oral Surgeon Montgomery<br />

Robinson Brian 002627 Maryland Oral Surgery Associates, PA 11120 New Hampshire Ave., Suite 501 Silver Spring MD 20904 Oral Surgeon Montgomery<br />

Stark Mitchell 002627 Maryland Oral Surgery Associates, PA 11120 New Hampshire Ave., Suite 501 Silver Spring MD 20904 Oral Surgeon Montgomery<br />

Trinh Huy 002627 Maryland Oral Surgery Associates, PA 11120 New Hampshire Ave., Suite 501 Silver Spring MD 20904 Oral Surgeon Montgomery<br />

Haghighiyan Majid 051079 Silver Spring <strong>Dental</strong> Care LLC 13321 New Hampshire Ave, Suite 201 Silver Spring MD 20904 General <strong>Provider</strong> Montgomery<br />

Wiltshire Cathy 072079 Straighten Up Orthodontics 2415 Musgrove Rd, Suite 307 Silver Spring MD 20904 Orthodontist Montgomery<br />

Hector Ricardo 037792 Aegis <strong>Dental</strong> Group 14440 Layhill Rd Silver Spring MD 20906 General <strong>Provider</strong> Montgomery<br />

Bayley Neil 050890 Aspen Hill <strong>Dental</strong> Specialists 13975 Connecticut Ave, Suite 200-201 Silver Spring MD 20906 Oral Surgeon Montgomery<br />

Dompkowski Douglas 050890 Aspen Hill <strong>Dental</strong> Specialists 13975 Connecticut Ave, Suite 200-201 Silver Spring MD 20906 Periodontist Montgomery<br />

Mills Cordelia 050890 Aspen Hill <strong>Dental</strong> Specialists 13975 Connecticut Ave, Suite 200-201 Silver Spring MD 20906 Endodontist Montgomery<br />

Bhangra Kuljeet 008779 Aspen Hill General And Cosmetic Dentistry 13975 Connecticut Avenue, Suite 200 Silver Spring MD 20906 General <strong>Provider</strong> Montgomery<br />

Goitom Liya 008779 Aspen Hill General And Cosmetic Dentistry 13975 Connecticut Avenue, Suite 200 Silver Spring MD 20906 General <strong>Provider</strong> Montgomery<br />

Goorah Soorita 008779 Aspen Hill General And Cosmetic Dentistry 13975 Connecticut Avenue, Suite 200 Silver Spring MD 20906 General <strong>Provider</strong> Montgomery<br />

Lee Richard 008779 Aspen Hill General And Cosmetic Dentistry 13975 Connecticut Avenue, Suite 200 Silver Spring MD 20906 Orthodontist Montgomery<br />

McLaughlin Kaye 008779 Aspen Hill General And Cosmetic Dentistry 13975 Connecticut Avenue, Suite 200 Silver Spring MD 20906 General <strong>Provider</strong> Montgomery<br />

Elkhateeb Mohammad 050327 TLC Modern Dentistry LLC 13623 H-I Georgia Ave Silver Spring MD 20906 General <strong>Provider</strong> Montgomery<br />

Le Chinh 050327 TLC Modern Dentistry LLC 13623 H-I Georgia Ave Silver Spring MD 20906 General <strong>Provider</strong> Montgomery<br />

Nguyen Helen 050327 TLC Modern Dentistry LLC 13623 H-I Georgia Ave Silver Spring MD 20906 General <strong>Provider</strong> Montgomery<br />

Tran Quang 050327 TLC Modern Dentistry LLC 13623 H-I Georgia Ave Silver Spring MD 20906 General <strong>Provider</strong> Montgomery<br />

* Achikeh Kingsley 000339 City Place <strong>Dental</strong> 8780 Georgia Ave Silver Spring MD 20910 General <strong>Provider</strong> Montgomery<br />

Batrouni Ziad 097863 MD Oral Surgery Associates of Silver Spring LLC 1300 Spring St, Suite 316 Silver Spring MD 20910 Oral Surgeon Montgomery<br />

Cohen Lisa 097863 MD Oral Surgery Associates of Silver Spring LLC 1300 Spring St, Suite 316 Silver Spring MD 20910 Oral Surgeon Montgomery<br />

Frey Bradley 097863 MD Oral Surgery Associates of Silver Spring LLC 1300 Spring St, Suite 316 Silver Spring MD 20910 Oral Surgeon Montgomery<br />

Griffith Miari-Ann 097863 MD Oral Surgery Associates of Silver Spring LLC 1300 Spring St, Suite 316 Silver Spring MD 20910 Oral Surgeon Montgomery<br />

Kishter Steven 097863 MD Oral Surgery Associates of Silver Spring LLC 1300 Spring St, Suite 316 Silver Spring MD 20910 Oral Surgeon Montgomery<br />

Nathan Glenn 097863 MD Oral Surgery Associates of Silver Spring LLC 1300 Spring St, Suite 316 Silver Spring MD 20910 Oral Surgeon Montgomery<br />

Patel Chirag 097863 MD Oral Surgery Associates of Silver Spring LLC 1300 Spring St, Suite 316 Silver Spring MD 20910 Oral Surgeon Montgomery<br />

Robinson Brian 097863 MD Oral Surgery Associates of Silver Spring LLC 1300 Spring St, Suite 316 Silver Spring MD 20910 Oral Surgeon Montgomery<br />

Stark Mitchell 097863 MD Oral Surgery Associates of Silver Spring LLC 1300 Spring St, Suite 316 Silver Spring MD 20910 Oral Surgeon Montgomery<br />

Trinh Huy 097863 MD Oral Surgery Associates of Silver Spring LLC 1300 Spring St, Suite 316 Silver Spring MD 20910 Oral Surgeon Montgomery<br />

Moazami Negin 000844 Negin A. Moazami, D.D.S. 8630 Fenton Street, Suite 902 Silver Spring MD 20910 General <strong>Provider</strong> Montgomery<br />

Scott Stuart 038016 Scott Orthodontics 804 Pershing Dr, Suite 106 Silver Spring MD 20910 Orthodontist Montgomery<br />

Warner Oswald 000282 Warner Family <strong>Dental</strong> Center 7000 Carroll Ave. Takoma Park MD 20912 General <strong>Provider</strong> Montgomery<br />

Vaughan William 000692 William E. Vaughan, D.D.S. 7600 Maple Ave. Suite 6 Takoma Park MD 20912 General <strong>Provider</strong> Montgomery<br />

* Winkelman Peter 000192 Sterling <strong>Dental</strong> Centers 12114 Georgia Avenue Wheaton MD 20902 General <strong>Provider</strong> Montgomery<br />

Brutus Jean-Daniel 068505 Kemmerton Family Dentistry 6000 Laurel-Bowie Rd, Suite 101 Bowie MD 20715 General <strong>Provider</strong> Prince Georges<br />

Menendez Leonardo 004374 Leo F Menendez DDS 3233 Superior Lane, Suite B23 Bowie MD 20715 Oral Surgeon Prince Georges<br />

Geballa Marc 000554 Marc G Geballa DDS 6911 Laurel-Bowie Rd., #313 Bowie MD 20715 Endodontist Prince Georges<br />

McKen Neville 000332 Neville McKen, D.D.S. 3060 Mitchellville Rd, Suite 213 Bowie MD 20715 General <strong>Provider</strong> Prince Georges<br />

Davis Tanzania 014419 Tanzania Davis DDS 3231 Superior Lane, Suite A 22 Bowie MD 20715 General <strong>Provider</strong> Prince Georges<br />

* Everett Dwayne 021563 Dwayne E Everett DDS 4000 Mitchellville Road, Suite A314 Bowie MD 20716 Oral Surgeon Prince Georges<br />

Vargas Eduardo 001680 Eduardo Vargas, D.D.S., M.S., PC 2905 Mitchellville Road, Suite 109 Bowie MD 20716 Prosthodontist Prince Georges<br />

Packman Harold 000758 Harold Packman, D.M.D., PA 14999 Health Cntr, Suite 110 Bowie MD 20716 Periodontist Prince Georges<br />

Ego Osuala Derek 051031 RCT Endodontics 3060 Mitchellville Rd, Suite 108 Bowie MD 20716 Endodontist Prince Georges<br />

Orgel Adam 051031 RCT Endodontics 3060 Mitchellville Rd, Suite 108 Bowie MD 20716 Endodontist Prince Georges<br />

Taylor Ronald 051031 RCT Endodontics 3060 Mitchellville Rd, Suite 108 Bowie MD 20716 Endodontist Prince Georges<br />

Labbe Stephen 000609 Stewart & Labbe, D.D.S., P.A. 4000 Mitcheville Road, Suite 316-318 Bowie MD 20716 Orthodontist Prince Georges<br />

Stewart Lamon 000609 Stewart & Labbe, D.D.S., P.A. 4000 Mitcheville Road, Suite 316-318 Bowie MD 20716 Orthodontist Prince Georges<br />

King Michael 072078 King Oral Surgery Group at Camp Springs 5801 Allentown Rd, Suite 408 Camp Springs MD 20746 Oral Surgeon Prince Georges<br />

Davis Vincent 000161 Gentle <strong>Dental</strong> Care / Dr. Vincent Davis 9146 Edgeworth Drive Capitol Heights MD 20743 General <strong>Provider</strong> Prince Georges<br />

McKen Neville 000333 Neville McKen, D.D.S. 9171 Central Ave., Suite L9 Capitol Heights MD 20743 General <strong>Provider</strong> Prince Georges<br />

Wilson Calvin 002862 Alpha <strong>Dental</strong> Care LLC 8975 Woodyard Rd Clinton MD 20735 General <strong>Provider</strong> Prince Georges<br />

Williams Alvin 037717 Alvin B Williams DDS 9135 Piscataway Rd, #105 Clinton MD 20735 General <strong>Provider</strong> Prince Georges<br />

Ego Osuala Derek 068508 Excelsis Root Canal Specialties 9113 Brandywine Rd Clinton MD 20735 Endodontist Prince Georges<br />

* Maloney Joseph 000735 Joseph A. Maloney, D.D.S. 9131 Piscataway Rd., Suite 739 Clinton MD 20735 General <strong>Provider</strong> Prince Georges<br />

Brager Stanley 037542 College Park <strong>Dental</strong> 7305 Baltimore Ave., #204 College Park MD 20740 General <strong>Provider</strong> Prince Georges<br />

Cherot Ani 037542 College Park <strong>Dental</strong> 7305 Baltimore Ave., #204 College Park MD 20740 General <strong>Provider</strong> Prince Georges<br />

Eghtesadi Ali 037542 College Park <strong>Dental</strong> 7305 Baltimore Ave., #204 College Park MD 20740 Endodontist Prince Georges<br />

Ghosh Gitanjali 037542 College Park <strong>Dental</strong> 7305 Baltimore Ave., #204 College Park MD 20740 General <strong>Provider</strong> Prince Georges<br />

Haghighiyan Majid 037542 College Park <strong>Dental</strong> 7305 Baltimore Ave., #204 College Park MD 20740 General <strong>Provider</strong> Prince Georges<br />

Hoang-Nguyen Jacquelyn 037542 College Park <strong>Dental</strong> 7305 Baltimore Ave., #204 College Park MD 20740 General <strong>Provider</strong> Prince Georges<br />

Hosain Rubeena 037542 College Park <strong>Dental</strong> 7305 Baltimore Ave., #204 College Park MD 20740 General <strong>Provider</strong> Prince Georges<br />

Kodsi Nadim 037542 College Park <strong>Dental</strong> 7305 Baltimore Ave., #204 College Park MD 20740 General <strong>Provider</strong> Prince Georges<br />

* Indicates dentist that is accepting current patients only.<br />

All <strong>Select</strong> <strong>Plan</strong> Dentists Page 7<br />

1 Same as a DHMO with fixed member copayments, no annual maximum dollar limits, no waiting periods, no deductibles, no pre-authorization paperwork or pre-treatment estimates and no<br />

claim forms or proof of loss (except in the case of out-of-area emergencies). Member must enroll with a General Dentist. Fac ID is used to indicate which facility a member chooses.


SELECT PLAN 1 DENTIST DIRECTORY<br />

Dentists listed are under contract as of 10/1/12<br />

Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />

Liu Chiun-lin 037542 College Park <strong>Dental</strong> 7305 Baltimore Ave., #204 College Park MD 20740 Periodontist Prince Georges<br />

Su Esther 037542 College Park <strong>Dental</strong> 7305 Baltimore Ave., #204 College Park MD 20740 General <strong>Provider</strong> Prince Georges<br />

Tiwary Romila 037542 College Park <strong>Dental</strong> 7305 Baltimore Ave., #204 College Park MD 20740 General <strong>Provider</strong> Prince Georges<br />

Toufanian Sanam 037542 College Park <strong>Dental</strong> 7305 Baltimore Ave., #204 College Park MD 20740 General <strong>Provider</strong> Prince Georges<br />

Lane Daniel 000346 Daniel J. Lane, D.D.S. 7307 Baltimore Ave., Suite 113 College Park MD 20740 General <strong>Provider</strong> Prince Georges<br />

Cohen Lisa 000565 Maryland Oral Surgery Associates 6201 Greenbelt Rd., M-1 College Park MD 20740 Oral Surgeon Prince Georges<br />

Griffith Miari-Ann 000565 Maryland Oral Surgery Associates 6201 Greenbelt Rd., M-1 College Park MD 20740 Oral Surgeon Prince Georges<br />

Kashyap Anil 000565 Maryland Oral Surgery Associates 6201 Greenbelt Rd., M-1 College Park MD 20740 Oral Surgeon Prince Georges<br />

Nathan Glenn 000565 Maryland Oral Surgery Associates 6201 Greenbelt Rd., M-1 College Park MD 20740 Oral Surgeon Prince Georges<br />

Patel Chirag 000565 Maryland Oral Surgery Associates 6201 Greenbelt Rd., M-1 College Park MD 20740 Oral Surgeon Prince Georges<br />

Robinson Brian 000565 Maryland Oral Surgery Associates 6201 Greenbelt Rd., M-1 College Park MD 20740 Oral Surgeon Prince Georges<br />

Stark Mitchell 000565 Maryland Oral Surgery Associates 6201 Greenbelt Rd., M-1 College Park MD 20740 Oral Surgeon Prince Georges<br />

Trinh Huy 000565 Maryland Oral Surgery Associates 6201 Greenbelt Rd., M-1 College Park MD 20740 Oral Surgeon Prince Georges<br />

Larosiliere Patrick 050978 Essence <strong>Dental</strong> Care 5805 Silver Hill Rd, Suite G District Heights MD 20747 Orthodontist Prince Georges<br />

Obianwu Chilo 050328 All Smiles <strong>Dental</strong> Care 12803 Old Fort Rd, Suite 203 Fort Washington MD 20744 General <strong>Provider</strong> Prince Georges<br />

Palumbo Pat 037677 Drs. Palumbo and Palumbo LLC 10905 Fort Washington Rd, 214 Fort Washington MD 20744 Oral Surgeon Prince Georges<br />

* McKen Neville 000334 Neville McKen DDS 8602 Dover St. Fort Washington MD 20744 General <strong>Provider</strong> Prince Georges<br />

Hymes Pamela 000330 Pamela V. Hymes, D.D.S., PA 10905 Fort Washington Rd., Suite 203 Fort Washington MD 20744 General <strong>Provider</strong> Prince Georges<br />

Bryant Larry 000738 Larry W. Bryant, D.D.S., PA 12200 Annapolis Rd, Suite 236 Glenn Dale MD 20769 Oral Surgeon Prince Georges<br />

Fisher Christopher 000658 Christopher L. Fisher, D.D.S., P.A. 7525 Greenway Center Dr. #109 Greenbelt MD 20770 Oral Surgeon Prince Georges<br />

Wilson Adly 001187 Greenbelt <strong>Dental</strong> Care, P.C. 7525 Greenway Center Dr., Suite 201 Greenbelt MD 20770 General <strong>Provider</strong> Prince Georges<br />

Green Stephen 000577 Stephen I. Green, D.D.S., P.A. 7501 Greenway Ctr. Dr. # 260 Greenbelt MD 20770 Periodontist Prince Georges<br />

Labbe Stephen 000607 Stewart & Labbe, D.D.S., P.A. 7525 Greenway Ctr. Dr. Greenbelt MD 20770 Orthodontist Prince Georges<br />

Stewart Lamon 000607 Stewart & Labbe, D.D.S., P.A. 7525 Greenway Ctr. Dr. Greenbelt MD 20770 Orthodontist Prince Georges<br />

Moore Brian 051085 Brian C Moore DMD PC 3311 Toledo Terr, Suite C102 Hyattsville MD 20782 General <strong>Provider</strong> Prince Georges<br />

Bronstein Arden 000407 Friendship <strong>Dental</strong> 6525 Belcrest Rd., Suite 208 Hyattsville MD 20782 General <strong>Provider</strong> Prince Georges<br />

Davis Vincent 001331 Gentle <strong>Dental</strong> Care/ Dr. Vincent Davis 1836 Metzerott Rd., #118 Hyattsville MD 20783 General <strong>Provider</strong> Prince Georges<br />

Tajick Gita 002523 Tajicks <strong>Dental</strong> Clinic 7411 Riggs Rd., #108 Hyattsville MD 20783 General <strong>Provider</strong> Prince Georges<br />

* DeHaas Daniel 000960 Daniel De Haas, D.D.S. 7101 Annapolis Road Hyattsville MD 20784 General <strong>Provider</strong> Prince Georges<br />

Hall, III Bert 002370 Hall and Associates 7221 East Ridge Drive Hyattsville MD 20785 General <strong>Provider</strong> Prince Georges<br />

* Winkelman Peter 000191 Sterling <strong>Dental</strong> Centers 7503 A Annapolis Road Landover Hills MD 20784 General <strong>Provider</strong> Prince Georges<br />

Klapper Harry 000186 Harry J. Klapper, D.D.S. 1300 Mercantile Ln., Suite 100E Largo MD 20774 General <strong>Provider</strong> Prince Georges<br />

* Larosiliere Patrick 050979 Woodview <strong>Dental</strong> Specialists 1401 Mercantile Ln, Suite 102 Largo MD 20774 Orthodontist Prince Georges<br />

Sanusi Jemi 001270 Yardee <strong>Dental</strong>/ Dr. Jemi Sanusi 1400 Mercantile Ln. Ste.224 Largo MD 20774 General <strong>Provider</strong> Prince Georges<br />

Eghtesadi Ali 070473 Ali Eghtesadi DDS 8363 Cherry Ln Laurel MD 20707 Endodontist Prince Georges<br />

Batz Richard 001053 Drs. Batz and Weiner Lake <strong>Dental</strong> 8363 Cherry Lane Laurel MD 20707 General <strong>Provider</strong> Prince Georges<br />

Brain Jeffrey 001053 Drs. Batz and Weiner Lake <strong>Dental</strong> 8363 Cherry Lane Laurel MD 20707 Periodontist Prince Georges<br />

Danesh Fariba 001053 Drs. Batz and Weiner Lake <strong>Dental</strong> 8363 Cherry Lane Laurel MD 20707 General <strong>Provider</strong> Prince Georges<br />

Dukes Jonathan 001053 Drs. Batz and Weiner Lake <strong>Dental</strong> 8363 Cherry Lane Laurel MD 20707 General <strong>Provider</strong> Prince Georges<br />

Kavandi Shoreh 001053 Drs. Batz and Weiner Lake <strong>Dental</strong> 8363 Cherry Lane Laurel MD 20707 General <strong>Provider</strong> Prince Georges<br />

Kim Sung 001053 Drs. Batz and Weiner Lake <strong>Dental</strong> 8363 Cherry Lane Laurel MD 20707 General <strong>Provider</strong> Prince Georges<br />

Narendra Asha 001053 Drs. Batz and Weiner Lake <strong>Dental</strong> 8363 Cherry Lane Laurel MD 20707 General <strong>Provider</strong> Prince Georges<br />

Nassiri Azadeh 001053 Drs. Batz and Weiner Lake <strong>Dental</strong> 8363 Cherry Lane Laurel MD 20707 General <strong>Provider</strong> Prince Georges<br />

Phaeton Nathalie 001053 Drs. Batz and Weiner Lake <strong>Dental</strong> 8363 Cherry Lane Laurel MD 20707 Pedodontist Prince Georges<br />

Seltzer Jared 001053 Drs. Batz and Weiner Lake <strong>Dental</strong> 8363 Cherry Lane Laurel MD 20707 Endodontist Prince Georges<br />

Shah Ali 001053 Drs. Batz and Weiner Lake <strong>Dental</strong> 8363 Cherry Lane Laurel MD 20707 General <strong>Provider</strong> Prince Georges<br />

Tan Chun 001053 Drs. Batz and Weiner Lake <strong>Dental</strong> 8363 Cherry Lane Laurel MD 20707 General <strong>Provider</strong> Prince Georges<br />

Wai Wai Sint 001053 Drs. Batz and Weiner Lake <strong>Dental</strong> 8363 Cherry Lane Laurel MD 20707 General <strong>Provider</strong> Prince Georges<br />

Weiner Mitchell 001053 Drs. Batz and Weiner Lake <strong>Dental</strong> 8363 Cherry Lane Laurel MD 20707 General <strong>Provider</strong> Prince Georges<br />

Skane Timothy 061294 Harbour Endodontics PA 8363 Cherry Ln Laurel MD 20707 Endodontist Prince Georges<br />

Abel Jarred 081558 Jarred S Abel DDS 8363 Cherry Ln Laurel MD 20707 Oral Surgeon Prince Georges<br />

Rubin Jessica 050399 Jessica L Exelbert DDS 8363 Cherry Lane Laurel MD 20707 Pedodontist Prince Georges<br />

Kim John 001199 John N. Kim, D.D.S., P.A. 8301 Cherry Ln. Laurel MD 20707 General <strong>Provider</strong> Prince Georges<br />

Abrahams Heather 002336 Orthodontic Associates 8361 Cherrylane Laurel MD 20707 Orthodontist Prince Georges<br />

Miller Jeffrey 002336 Orthodontic Associates 8361 Cherrylane Laurel MD 20707 Orthodontist Prince Georges<br />

Williams David 002336 Orthodontic Associates 8361 Cherrylane Laurel MD 20707 Orthodontist Prince Georges<br />

Jones Ronnie 061295 Ronnie K Jones DDS 8363 Cherry Ln Laurel MD 20707 Periodontist Prince Georges<br />

Russell Sharon 050411 Sharon S Russell DDS 8363 Cherry Lane Laurel MD 20707 Oral Surgeon Prince Georges<br />

Heller Alan 002482 Alan R. Heller, D.D.S., M.S. 9811 Mallard Drive, #201 Laurel MD 20708 Orthodontist Prince Georges<br />

Abdullah Aslim 000581 Aslim Abdullah, D.D.S. 14333 Laurel-Bowie Rd. # 300 Laurel MD 20708 Endodontist Prince Georges<br />

Baldinger Jill 000538 Drs. Levine & Decker 14333 Laurel-Bowie Rd., Suite 201 Laurel MD 20708 Orthodontist Prince Georges<br />

Lavine David 000538 Drs. Levine & Decker 14333 Laurel-Bowie Rd., Suite 201 Laurel MD 20708 Orthodontist Prince Georges<br />

Cohen Lisa 000567 Maryland Oral Surgery Associates 14333 Laurel Bowie Rd., #205 Laurel MD 20708 Oral Surgeon Prince Georges<br />

Frey Bradley 000567 Maryland Oral Surgery Associates 14333 Laurel Bowie Rd., #205 Laurel MD 20708 Oral Surgeon Prince Georges<br />

Griffith Miari-Ann 000567 Maryland Oral Surgery Associates 14333 Laurel Bowie Rd., #205 Laurel MD 20708 Oral Surgeon Prince Georges<br />

Kashyap Anil 000567 Maryland Oral Surgery Associates 14333 Laurel Bowie Rd., #205 Laurel MD 20708 Oral Surgeon Prince Georges<br />

* Indicates dentist that is accepting current patients only.<br />

All <strong>Select</strong> <strong>Plan</strong> Dentists Page 8<br />

1 Same as a DHMO with fixed member copayments, no annual maximum dollar limits, no waiting periods, no deductibles, no pre-authorization paperwork or pre-treatment estimates and no<br />

claim forms or proof of loss (except in the case of out-of-area emergencies). Member must enroll with a General Dentist. Fac ID is used to indicate which facility a member chooses.


SELECT PLAN 1 DENTIST DIRECTORY<br />

Dentists listed are under contract as of 10/1/12<br />

Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />

Patel Chirag 000567 Maryland Oral Surgery Associates 14333 Laurel Bowie Rd., #205 Laurel MD 20708 Oral Surgeon Prince Georges<br />

Robinson Brian 000567 Maryland Oral Surgery Associates 14333 Laurel Bowie Rd., #205 Laurel MD 20708 Oral Surgeon Prince Georges<br />

Stark Mitchell 000567 Maryland Oral Surgery Associates 14333 Laurel Bowie Rd., #205 Laurel MD 20708 Oral Surgeon Prince Georges<br />

Trinh Huy 000567 Maryland Oral Surgery Associates 14333 Laurel Bowie Rd., #205 Laurel MD 20708 Oral Surgeon Prince Georges<br />

Criscitiello Kevin 002118 Ulery <strong>Dental</strong> & Orthodontics 12793 Laurel Bowie Road Laurel MD 20708 General <strong>Provider</strong> Prince Georges<br />

DeMizio Peter 002118 Ulery <strong>Dental</strong> & Orthodontics 12793 Laurel Bowie Road Laurel MD 20708 Oral Surgeon Prince Georges<br />

Elrafei Mohamed 002118 Ulery <strong>Dental</strong> & Orthodontics 12793 Laurel Bowie Road Laurel MD 20708 General <strong>Provider</strong> Prince Georges<br />

Ganjavian Babak 002118 Ulery <strong>Dental</strong> & Orthodontics 12793 Laurel Bowie Road Laurel MD 20708 General <strong>Provider</strong> Prince Georges<br />

Gentile Michael 002118 Ulery <strong>Dental</strong> & Orthodontics 12793 Laurel Bowie Road Laurel MD 20708 Oral Surgeon Prince Georges<br />

Ghajarnia Katayoun 002118 Ulery <strong>Dental</strong> & Orthodontics 12793 Laurel Bowie Road Laurel MD 20708 General <strong>Provider</strong> Prince Georges<br />

Ghajarnia M. Reza 002118 Ulery <strong>Dental</strong> & Orthodontics 12793 Laurel Bowie Road Laurel MD 20708 Orthodontist Prince Georges<br />

Jun Sung 002118 Ulery <strong>Dental</strong> & Orthodontics 12793 Laurel Bowie Road Laurel MD 20708 General <strong>Provider</strong> Prince Georges<br />

Mankiewicz Ryan 002118 Ulery <strong>Dental</strong> & Orthodontics 12793 Laurel Bowie Road Laurel MD 20708 General <strong>Provider</strong> Prince Georges<br />

Masood Arif 002118 Ulery <strong>Dental</strong> & Orthodontics 12793 Laurel Bowie Road Laurel MD 20708 General <strong>Provider</strong> Prince Georges<br />

Steinberg Wayne 002118 Ulery <strong>Dental</strong> & Orthodontics 12793 Laurel Bowie Road Laurel MD 20708 General <strong>Provider</strong> Prince Georges<br />

Tchakarova Ludmila 002118 Ulery <strong>Dental</strong> & Orthodontics 12793 Laurel Bowie Road Laurel MD 20708 General <strong>Provider</strong> Prince Georges<br />

Ulery Scott 002118 Ulery <strong>Dental</strong> & Orthodontics 12793 Laurel Bowie Road Laurel MD 20708 General <strong>Provider</strong> Prince Georges<br />

Weiss Karl 002118 Ulery <strong>Dental</strong> & Orthodontics 12793 Laurel Bowie Road Laurel MD 20708 Orthodontist Prince Georges<br />

Wolf Christopher 002118 Ulery <strong>Dental</strong> & Orthodontics 12793 Laurel Bowie Road Laurel MD 20708 General <strong>Provider</strong> Prince Georges<br />

Harmon David 061300 David E Harmon Jr DDS MSD PA 10264 Lake Arbor Way Mitchellville MD 20721 Orthodontist Prince Georges<br />

Frankenberry Anishka 000324 David G. O'Neal, D.D.S., & Assoc. 6188 Oxon Hill Rd., Suite 200 Oxon Hill MD 20745 Orthodontist Prince Georges<br />

O'Neal David 000324 David G. O'Neal, D.D.S., & Assoc. 6188 Oxon Hill Rd., Suite 200 Oxon Hill MD 20745 General <strong>Provider</strong> Prince Georges<br />

Rasul Afia 000324 David G. O'Neal, D.D.S., & Assoc. 6188 Oxon Hill Rd., Suite 200 Oxon Hill MD 20745 General <strong>Provider</strong> Prince Georges<br />

Meyer Emory 061335 E Ross Meyer DDS 6130 Oxon Hill Rd, Suite 305 Oxon Hill MD 20745 Oral Surgeon Prince Georges<br />

Monroe Quentin 037629 Quentin E Monroe <strong>Dental</strong> <strong>Services</strong> 5448 St. Barnabas Rd. Oxon Hill MD 20745 General <strong>Provider</strong> Prince Georges<br />

Ruderman Carl 000555 Carl Ruderman DDS PA 6315 Baltimore Ave. Riverdale MD 20737 Oral Surgeon Prince Georges<br />

* Blumenfeld Frederick 000210 The <strong>Dental</strong> Group 6200 Baltimore Ave., Ste. 200 Riverdale MD 20737 General <strong>Provider</strong> Prince Georges<br />

* Digregorio Anthony 000210 The <strong>Dental</strong> Group 6200 Baltimore Ave., Ste. 200 Riverdale MD 20737 General <strong>Provider</strong> Prince Georges<br />

* Pourhmad Haghig Payam 000210 The <strong>Dental</strong> Group 6200 Baltimore Ave., Ste. 200 Riverdale MD 20737 General <strong>Provider</strong> Prince Georges<br />

* Sease, Jr. Tillman 000210 The <strong>Dental</strong> Group 6200 Baltimore Ave., Ste. 200 Riverdale MD 20737 General <strong>Provider</strong> Prince Georges<br />

* Tajick Ramien 000210 The <strong>Dental</strong> Group 6200 Baltimore Ave., Ste. 200 Riverdale MD 20737 General <strong>Provider</strong> Prince Georges<br />

Regil Teresa 002850 The <strong>Dental</strong> Group - Teresa Regil, D.D.S. 6200 Baltimore Avenue, Suite 200 Riverdale MD 20737 Pedodontist Prince Georges<br />

Frankle Kathleen 002849 The <strong>Dental</strong> Group Specialists 6200 Baltimore Ave. Riverdale MD 20737 Endodontist Prince Georges<br />

Park Sarah 002849 The <strong>Dental</strong> Group Specialists 6200 Baltimore Ave. Riverdale MD 20737 Periodontist Prince Georges<br />

Smith Dezrie 016470 Suitland <strong>Dental</strong> Center 4814 Silver Hill Road Suitland MD 20746 General <strong>Provider</strong> Prince Georges<br />

Obianwu Chilo 037663 All Smiles <strong>Dental</strong> Care 3847 Branch Ave, Suite 124 Temple Hills MD 20748 General <strong>Provider</strong> Prince Georges<br />

Kang Sinha 079801 <strong>Dental</strong> Associates of Greater MD at Temple Hills 6339 Allentown Road, Suite E Temple Hills MD 20748 General <strong>Provider</strong> Prince Georges<br />

Park Stanley 079801 <strong>Dental</strong> Associates of Greater MD at Temple Hills 6339 Allentown Road, Suite E Temple Hills MD 20748 General <strong>Provider</strong> Prince Georges<br />

Yoon Jangyeul 079801 <strong>Dental</strong> Associates of Greater MD at Temple Hills 6339 Allentown Road, Suite E Temple Hills MD 20748 General <strong>Provider</strong> Prince Georges<br />

Granger Kevin 051072 Oral Health Associates 4316 St Barnabas Rd Temple Hills MD 20748 General <strong>Provider</strong> Prince Georges<br />

Klapper Harry 000187 Harry J. Klapper, D.D.S. 5749 Crain Hwy. Upper Marlboro MD 20772 General <strong>Provider</strong> Prince Georges<br />

Hlousek Lubor 001441 Walzer Sullivan and Hlousek PA 102 Saint Claire Place Stevensville MD 21666 Oral Surgeon Queen Annes<br />

Jones Kurt 001441 Walzer Sullivan and Hlousek PA 102 Saint Claire Place Stevensville MD 21666 Oral Surgeon Queen Annes<br />

Sullivan Cornelius 001441 Walzer Sullivan and Hlousek PA 102 Saint Claire Place Stevensville MD 21666 Oral Surgeon Queen Annes<br />

Walzer Clifford 001441 Walzer Sullivan and Hlousek PA 102 Saint Claire Place Stevensville MD 21666 Oral Surgeon Queen Annes<br />

Doumit Antoine 061331 Antoine Doumit DMD CAGS PC 23140 Moakley St, Suite 3 Leonardtown MD 20650 Orthodontist Saint Marys<br />

Robertson Robert 000462 Antietam Valley <strong>Dental</strong> Center 1246 Maryland Avenue Hagerstown MD 21740 General <strong>Provider</strong> Washington<br />

Robertson Robert 068461 Antietam Valley <strong>Dental</strong> Center 257 W Main St Hancock MD 21750 General <strong>Provider</strong> Washington<br />

Forno Donald 037588 Eastern Shore Endodontics 1411 Wesley Dr. Salisbury MD 21801 Endodontist Wicomico<br />

Lee Young 037588 Eastern Shore Endodontics 1411 Wesley Dr. Salisbury MD 21801 Endodontist Wicomico<br />

Quillin Bartley 037588 Eastern Shore Endodontics 1411 Wesley Dr. Salisbury MD 21801 Endodontist Wicomico<br />

Viertl George 002319 George C. Viertl, D.D.S., P.C. 560 Riverside Dr., Suite B206 Salisbury MD 21801 General <strong>Provider</strong> Wicomico<br />

Ascher Lynn 001557 Lynn F. Ascher, D.M.D., P.A. 560 Riverside Drive, Suite B-201 Salisbury MD 21801 Oral Surgeon Wicomico<br />

Jain Arvind 002767 Delaware Maryland <strong>Dental</strong> 123 West College Ave. Salisbury MD 21804 General <strong>Provider</strong> Wicomico<br />

Steinberg Robert 033847 Robert D Steinberg DDS 11204 Racetrack Rd, Pavillions Suite 102 Ocean Pines MD 21811 General <strong>Provider</strong> Worcester<br />

Jahansouz Maryam 002603 Sunflower <strong>Dental</strong> Group 90 Main Street, Suite 203 Hackensack NJ 07601 General <strong>Provider</strong> Bergen<br />

Greenberg Jessica 002693 North Arlington Orthodontics 64 Ridge Rd. N Arlington NJ 07031 Orthodontist Bergen<br />

Chew Dennis 000395 Cosmopolitan <strong>Dental</strong> LLC 10000 Lincoln Dr E, Suite 106 Marlton NJ 08053 General <strong>Provider</strong> Burlington<br />

Tinkelman Carl 001319 Stephen E. Shpeen, D.M.D., PC 30 Jackson Rd., Suite C Medford NJ 08055 Endodontist Burlington<br />

Blumenthal Mitchel 002809 American <strong>Dental</strong> Care, PA 61 S. Blackhorse Pike Blackwood NJ 08012 General <strong>Provider</strong> Camden<br />

Casey Joseph 002809 American <strong>Dental</strong> Care, PA 61 S. Blackhorse Pike Blackwood NJ 08012 General <strong>Provider</strong> Camden<br />

Choksi Raj 002809 American <strong>Dental</strong> Care, PA 61 S. Blackhorse Pike Blackwood NJ 08012 General <strong>Provider</strong> Camden<br />

Costello William 002809 American <strong>Dental</strong> Care, PA 61 S. Blackhorse Pike Blackwood NJ 08012 General <strong>Provider</strong> Camden<br />

Gershkovich Candace 002809 American <strong>Dental</strong> Care, PA 61 S. Blackhorse Pike Blackwood NJ 08012 General <strong>Provider</strong> Camden<br />

Khan Aliya 002809 American <strong>Dental</strong> Care, PA 61 S. Blackhorse Pike Blackwood NJ 08012 General <strong>Provider</strong> Camden<br />

Koff Howard 002809 American <strong>Dental</strong> Care, PA 61 S. Blackhorse Pike Blackwood NJ 08012 Orthodontist Camden<br />

* Indicates dentist that is accepting current patients only.<br />

All <strong>Select</strong> <strong>Plan</strong> Dentists Page 9<br />

1 Same as a DHMO with fixed member copayments, no annual maximum dollar limits, no waiting periods, no deductibles, no pre-authorization paperwork or pre-treatment estimates and no<br />

claim forms or proof of loss (except in the case of out-of-area emergencies). Member must enroll with a General Dentist. Fac ID is used to indicate which facility a member chooses.


SELECT PLAN 1 DENTIST DIRECTORY<br />

Dentists listed are under contract as of 10/1/12<br />

Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />

Levy Jamie 002809 American <strong>Dental</strong> Care, PA 61 S. Blackhorse Pike Blackwood NJ 08012 Oral Surgeon Camden<br />

Li Fuming 002809 American <strong>Dental</strong> Care, PA 61 S. Blackhorse Pike Blackwood NJ 08012 General <strong>Provider</strong> Camden<br />

Morgenstern Thomas 002809 American <strong>Dental</strong> Care, PA 61 S. Blackhorse Pike Blackwood NJ 08012 Orthodontist Camden<br />

Ruggieri John 002809 American <strong>Dental</strong> Care, PA 61 S. Blackhorse Pike Blackwood NJ 08012 General <strong>Provider</strong> Camden<br />

Gelman Robert 000661 Gelman <strong>Dental</strong> Associates 639 Market Street Camden NJ 08102 General <strong>Provider</strong> Camden<br />

Kaye Gary 000661 Gelman <strong>Dental</strong> Associates 639 Market Street Camden NJ 08102 General <strong>Provider</strong> Camden<br />

Bandola Krystin 000710 Matthew Eichen, D.M.D., P.A. 17 W. Ormond Ave Cherry Hill NJ 08034 Oral Surgeon Camden<br />

Chi Kai-Zu 000710 Matthew Eichen, D.M.D., P.A. 17 W. Ormond Ave Cherry Hill NJ 08034 Oral Surgeon Camden<br />

Eichen Matthew 000710 Matthew Eichen, D.M.D., P.A. 17 W. Ormond Ave Cherry Hill NJ 08034 Oral Surgeon Camden<br />

* Friedland Gary 000717 Fries Mill <strong>Dental</strong> Associates, P.A. 188 Fries Mill Road, L-3 Turnersville NJ 08012 General <strong>Provider</strong> Camden<br />

Casey Joseph 002864 American <strong>Dental</strong> Care, PA 2 Sheppard Rd., Suite 100 Voorhees NJ 08043 General <strong>Provider</strong> Camden<br />

Choksi Raj 002864 American <strong>Dental</strong> Care, PA 2 Sheppard Rd., Suite 100 Voorhees NJ 08043 General <strong>Provider</strong> Camden<br />

Costello William 002864 American <strong>Dental</strong> Care, PA 2 Sheppard Rd., Suite 100 Voorhees NJ 08043 General <strong>Provider</strong> Camden<br />

Gershkovich Candace 002864 American <strong>Dental</strong> Care, PA 2 Sheppard Rd., Suite 100 Voorhees NJ 08043 General <strong>Provider</strong> Camden<br />

Khan Aliya 002864 American <strong>Dental</strong> Care, PA 2 Sheppard Rd., Suite 100 Voorhees NJ 08043 General <strong>Provider</strong> Camden<br />

Koff Howard 002864 American <strong>Dental</strong> Care, PA 2 Sheppard Rd., Suite 100 Voorhees NJ 08043 Orthodontist Camden<br />

Li Fuming 002864 American <strong>Dental</strong> Care, PA 2 Sheppard Rd., Suite 100 Voorhees NJ 08043 General <strong>Provider</strong> Camden<br />

Morgenstern Thomas 002864 American <strong>Dental</strong> Care, PA 2 Sheppard Rd., Suite 100 Voorhees NJ 08043 Orthodontist Camden<br />

Ruggieri John 002864 American <strong>Dental</strong> Care, PA 2 Sheppard Rd., Suite 100 Voorhees NJ 08043 General <strong>Provider</strong> Camden<br />

Mashru Poonam 050733 Family <strong>Dental</strong> Care of South Jersey 707 Haddonfield Berlin Road Voorhees NJ 08043 General <strong>Provider</strong> Camden<br />

Schupper Jeffrey 050733 Family <strong>Dental</strong> Care of South Jersey 707 Haddonfield Berlin Road Voorhees NJ 08043 General <strong>Provider</strong> Camden<br />

Tenbrook James 080789 Tenbrook Orthodontics 508 Shiloh Pike Bridgeton NJ 08302 Orthodontist Cumberland<br />

Tenbrook James 080792 Tenbrook Orthodontics 1030 N High Street Millville NJ 08332 Orthodontist Cumberland<br />

Tenbrook James 080787 Tenbrook Orthodontics 1101 Wheaton Ave Millville NJ 08332 Orthodontist Cumberland<br />

Bandola Krystin 069551 Matthew Eichen, D.M.D., P.A. 83 S State St Vineland NJ 08360 Oral Surgeon Cumberland<br />

Chi Kai-Zu 069551 Matthew Eichen, D.M.D., P.A. 83 S State St Vineland NJ 08360 Oral Surgeon Cumberland<br />

Eichen Matthew 069551 Matthew Eichen, D.M.D., P.A. 83 S State St Vineland NJ 08360 Oral Surgeon Cumberland<br />

Tenbrook James 080786 Tenbrook Orthodontics 630 Brewster Rd, Unit D-1 Vineland NJ 08361 Orthodontist Cumberland<br />

Pericci Jeffrey 000724 Jeffrey M. Perricci, D.M.D. 123 Van Buren Street Newark NJ 07105 General <strong>Provider</strong> Essex<br />

Azizogli Amer 000834 Amer Azizogli, D.D.S. 175 Franklin Ave., Suite 101 Nutley NJ 07110 General <strong>Provider</strong> Essex<br />

Casey Joseph 002806 American <strong>Dental</strong> Care, PA 1450 Clements Bridge Rd. Deptford NJ 08096 General <strong>Provider</strong> Gloucester<br />

Choksi Raj 002806 American <strong>Dental</strong> Care, PA 1450 Clements Bridge Rd. Deptford NJ 08096 General <strong>Provider</strong> Gloucester<br />

Costello William 002806 American <strong>Dental</strong> Care, PA 1450 Clements Bridge Rd. Deptford NJ 08096 General <strong>Provider</strong> Gloucester<br />

Gacita Anthony 002806 American <strong>Dental</strong> Care, PA 1450 Clements Bridge Rd. Deptford NJ 08096 General <strong>Provider</strong> Gloucester<br />

Gershkovich Candace 002806 American <strong>Dental</strong> Care, PA 1450 Clements Bridge Rd. Deptford NJ 08096 General <strong>Provider</strong> Gloucester<br />

Khan Aliya 002806 American <strong>Dental</strong> Care, PA 1450 Clements Bridge Rd. Deptford NJ 08096 General <strong>Provider</strong> Gloucester<br />

Koff Howard 002806 American <strong>Dental</strong> Care, PA 1450 Clements Bridge Rd. Deptford NJ 08096 Orthodontist Gloucester<br />

Li Fuming 002806 American <strong>Dental</strong> Care, PA 1450 Clements Bridge Rd. Deptford NJ 08096 General <strong>Provider</strong> Gloucester<br />

Morgenstern Thomas 002806 American <strong>Dental</strong> Care, PA 1450 Clements Bridge Rd. Deptford NJ 08096 Orthodontist Gloucester<br />

Ruggieri John 002806 American <strong>Dental</strong> Care, PA 1450 Clements Bridge Rd. Deptford NJ 08096 General <strong>Provider</strong> Gloucester<br />

Shamseddin Seyed 002806 American <strong>Dental</strong> Care, PA 1450 Clements Bridge Rd. Deptford NJ 08096 Periodontist Gloucester<br />

Tenbrook James 080790 Tenbrook Orthodontics 108 Route 322, Unit 3 Mullica Hill NJ 08062 Orthodontist Gloucester<br />

Tenbrook James 080793 Tenbrook Orthodontics 304 Hurffville Crosskeys Rd Sewell NJ 08080 Orthodontist Gloucester<br />

Eslami Ali 001305 Turnersville Family Dentistry 123 Eggharbor Rd. Sewell NJ 08080 General <strong>Provider</strong> Gloucester<br />

Tenbrook James 080788 Tenbrook Orthodontics 1630 Route 322, Suite B Woolwich Township NJ 08085 Orthodontist Gloucester<br />

Gerhard Ronald 000811 Ronald F Gerhard DDS PA 834 Avenue C Bayonne NJ 07002 Periodontist Hudson<br />

Vahid Arash 072101 AV <strong>Dental</strong> Associates PA 642 Newark Ave Jersey City NJ 07306 General <strong>Provider</strong> Hudson<br />

Pericci Jeffrey 000714 Jeffrey M. Perricci, D.M.D. 594 Kearny Avenue, P.O. Box 523 Kearny NJ 07032 General <strong>Provider</strong> Hudson<br />

Eisenberg Adam 000685 Adam G. Eisenberg, D.D.S. 710 Alexander Rd. Princeton NJ 08540 General <strong>Provider</strong> Mercer<br />

Patel Priya 033850 Personalized <strong>Dental</strong> Care, P.C. 805 Inman Ave Colonia NJ 07067 General <strong>Provider</strong> Middlesex<br />

Zhu Lin 033864 New Century <strong>Dental</strong>, <strong>Inc</strong>. 2163 Oak Tree Rd., Suite 106 Edison NJ 08820 General <strong>Provider</strong> Middlesex<br />

Patel Paresh 002730 Healthy Smiles <strong>Dental</strong> Assoc, LLC 295 Main Street Metuchen NJ 08840 General <strong>Provider</strong> Middlesex<br />

Eisenberg Adam 000485 Adam G. Eisenberg, D.D.S. Central Mediplex, 495 Iron Bridge Rd. #9 Freehold NJ 07728 General <strong>Provider</strong> Monmouth<br />

Eisenberg Adam 037713 Drs. Eisenberg of Ocean 2002 Sunset Ave Ocean NJ 07712 General <strong>Provider</strong> Monmouth<br />

Gerhard Ronald 002137 Ronald F Gerhard DDS PA 225 Highway 35 Red Bank NJ 07701 Periodontist Monmouth<br />

Festina Alla 002564 Alla Festina, DDS, PC 301 Prospect Avenue Pine Beach NJ 08741 General <strong>Provider</strong> Ocean<br />

Yassein Ibraheim 002598 <strong>Dental</strong> Care Center 426 Union Ave. Paterson NJ 07502 General <strong>Provider</strong> Passaic<br />

Tenbrook James 080791 Tenbrook Orthodontics 8596 Route 40 / Route 45 Woodstown NJ 08098 Orthodontist Salem<br />

Anithottam Abraham 002816 Abraham Joseph Anithottam 390 Amwell Road, Suite 102 Hillsborough NJ 08844 Orthodontist Somerset<br />

Karandikar Rajashree 079090 Manville <strong>Dental</strong> Group LLC 7 Washington Ave Manville NJ 08835 General <strong>Provider</strong> Somerset<br />

Small Gary 079090 Manville <strong>Dental</strong> Group LLC 7 Washington Ave Manville NJ 08835 General <strong>Provider</strong> Somerset<br />

Trivedi Nirali 079090 Manville <strong>Dental</strong> Group LLC 7 Washington Ave Manville NJ 08835 General <strong>Provider</strong> Somerset<br />

Wadhwa Nandhi 079090 Manville <strong>Dental</strong> Group LLC 7 Washington Ave Manville NJ 08835 General <strong>Provider</strong> Somerset<br />

Emmert Richard 001487 Emmert <strong>Dental</strong> Associates, P.C. 2404 Oxford Drive Bethel Park PA 15102 General <strong>Provider</strong> Allegheny<br />

Manalo Arsenio 001209 Manalo Family Dentistry, P.C. 2414 Lytle Rd.,Ste. 106 Bethel Park PA 15102 General <strong>Provider</strong> Allegheny<br />

Adams William 000985 Katsur <strong>Dental</strong> & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 General <strong>Provider</strong> Allegheny<br />

* Indicates dentist that is accepting current patients only.<br />

All <strong>Select</strong> <strong>Plan</strong> Dentists Page 10<br />

1 Same as a DHMO with fixed member copayments, no annual maximum dollar limits, no waiting periods, no deductibles, no pre-authorization paperwork or pre-treatment estimates and no<br />

claim forms or proof of loss (except in the case of out-of-area emergencies). Member must enroll with a General Dentist. Fac ID is used to indicate which facility a member chooses.


SELECT PLAN 1 DENTIST DIRECTORY<br />

Dentists listed are under contract as of 10/1/12<br />

Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />

Affolter John 000985 Katsur <strong>Dental</strong> & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 General <strong>Provider</strong> Allegheny<br />

Alagirisamy Kiruthika 000985 Katsur <strong>Dental</strong> & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 General <strong>Provider</strong> Allegheny<br />

Carozza Roselyn 000985 Katsur <strong>Dental</strong> & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 General <strong>Provider</strong> Allegheny<br />

Cohen Ira 000985 Katsur <strong>Dental</strong> & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 General <strong>Provider</strong> Allegheny<br />

Dahar Nicholas 000985 Katsur <strong>Dental</strong> & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 Orthodontist Allegheny<br />

Damich Louis 000985 Katsur <strong>Dental</strong> & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 General <strong>Provider</strong> Allegheny<br />

Ghaffari Catherine 000985 Katsur <strong>Dental</strong> & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 General <strong>Provider</strong> Allegheny<br />

Ghajarnia M. Reza 000985 Katsur <strong>Dental</strong> & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 Orthodontist Allegheny<br />

Gillen Steve 000985 Katsur <strong>Dental</strong> & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 General <strong>Provider</strong> Allegheny<br />

Iszkula Steven 000985 Katsur <strong>Dental</strong> & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 Orthodontist Allegheny<br />

Katsur James 000985 Katsur <strong>Dental</strong> & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 General <strong>Provider</strong> Allegheny<br />

Khurana Leena 000985 Katsur <strong>Dental</strong> & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 General <strong>Provider</strong> Allegheny<br />

Kier Calvin 000985 Katsur <strong>Dental</strong> & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 General <strong>Provider</strong> Allegheny<br />

King David 000985 Katsur <strong>Dental</strong> & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 Orthodontist Allegheny<br />

Kolla Siva 000985 Katsur <strong>Dental</strong> & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 General <strong>Provider</strong> Allegheny<br />

Lewis Howell 000985 Katsur <strong>Dental</strong> & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 Orthodontist Allegheny<br />

Miller Van 000985 Katsur <strong>Dental</strong> & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 Orthodontist Allegheny<br />

Pryor Leroy 000985 Katsur <strong>Dental</strong> & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 General <strong>Provider</strong> Allegheny<br />

Rinchuse Dara 000985 Katsur <strong>Dental</strong> & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 Orthodontist Allegheny<br />

Schmidt Alan 000985 Katsur <strong>Dental</strong> & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 General <strong>Provider</strong> Allegheny<br />

Smiga Ingrid 000985 Katsur <strong>Dental</strong> & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 General <strong>Provider</strong> Allegheny<br />

Stein Mark 000985 Katsur <strong>Dental</strong> & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 General <strong>Provider</strong> Allegheny<br />

Tinnemeyer Anjuli 000985 Katsur <strong>Dental</strong> & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 General <strong>Provider</strong> Allegheny<br />

Zalakar Frank 000985 Katsur <strong>Dental</strong> & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 General <strong>Provider</strong> Allegheny<br />

Dandashi Moutaz 050688 Katsur <strong>Dental</strong> & Orthodontics Specialists 1597 Washington Pike, Suite A5 Bridgeville PA 15017 Pedodontist Allegheny<br />

Hertzler L Gregory 050688 Katsur <strong>Dental</strong> & Orthodontics Specialists 1597 Washington Pike, Suite A5 Bridgeville PA 15017 Oral Surgeon Allegheny<br />

Kelly Derek 050688 Katsur <strong>Dental</strong> & Orthodontics Specialists 1597 Washington Pike, Suite A5 Bridgeville PA 15017 Oral Surgeon Allegheny<br />

Kier Gregory 050688 Katsur <strong>Dental</strong> & Orthodontics Specialists 1597 Washington Pike, Suite A5 Bridgeville PA 15017 Periodontist Allegheny<br />

Monti Richard 050688 Katsur <strong>Dental</strong> & Orthodontics Specialists 1597 Washington Pike, Suite A5 Bridgeville PA 15017 Oral Surgeon Allegheny<br />

Iurlano David 001246 David Iurlano, D.M.D. 1101 Fifth Ave. Coraopolis PA 15108 General <strong>Provider</strong> Allegheny<br />

Mancini James 001280 James Mancini, D.M.D., P.C. 327 Forest Grove Rd. Coraopolis PA 15108 General <strong>Provider</strong> Allegheny<br />

Wintner Morton 001749 Morton Wintner, D.M.D. 850 Beaver Grade Rd. Coraopolis PA 15108 Orthodontist Allegheny<br />

Wielechowski David 051077 DMW Family Dentistry 5318 Ranalli Dr, Suite 410 Gibsonia PA 15044 General <strong>Provider</strong> Allegheny<br />

Affolter John 002117 Katsur <strong>Dental</strong> & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 General <strong>Provider</strong> Allegheny<br />

Alagirisamy Kiruthika 002117 Katsur <strong>Dental</strong> & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 General <strong>Provider</strong> Allegheny<br />

Carozza Roselyn 002117 Katsur <strong>Dental</strong> & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 General <strong>Provider</strong> Allegheny<br />

Cohen Ira 002117 Katsur <strong>Dental</strong> & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 General <strong>Provider</strong> Allegheny<br />

Dahar Nicholas 002117 Katsur <strong>Dental</strong> & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 Orthodontist Allegheny<br />

Damich Louis 002117 Katsur <strong>Dental</strong> & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 General <strong>Provider</strong> Allegheny<br />

Dandashi Moutaz 002117 Katsur <strong>Dental</strong> & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 Pedodontist Allegheny<br />

Ghaffari Catherine 002117 Katsur <strong>Dental</strong> & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 General <strong>Provider</strong> Allegheny<br />

Ghajarnia M. Reza 002117 Katsur <strong>Dental</strong> & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 Orthodontist Allegheny<br />

Gillen Steve 002117 Katsur <strong>Dental</strong> & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 General <strong>Provider</strong> Allegheny<br />

Hertzler L Gregory 002117 Katsur <strong>Dental</strong> & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 Oral Surgeon Allegheny<br />

Iszkula Steven 002117 Katsur <strong>Dental</strong> & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 Orthodontist Allegheny<br />

Katsur James 002117 Katsur <strong>Dental</strong> & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 General <strong>Provider</strong> Allegheny<br />

Kelly Derek 002117 Katsur <strong>Dental</strong> & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 Oral Surgeon Allegheny<br />

Khurana Leena 002117 Katsur <strong>Dental</strong> & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 General <strong>Provider</strong> Allegheny<br />

Kier Calvin 002117 Katsur <strong>Dental</strong> & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 General <strong>Provider</strong> Allegheny<br />

Kier Gregory 002117 Katsur <strong>Dental</strong> & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 Periodontist Allegheny<br />

King David 002117 Katsur <strong>Dental</strong> & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 Orthodontist Allegheny<br />

Kolla Siva 002117 Katsur <strong>Dental</strong> & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 General <strong>Provider</strong> Allegheny<br />

Lewis Howell 002117 Katsur <strong>Dental</strong> & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 Orthodontist Allegheny<br />

Miller Van 002117 Katsur <strong>Dental</strong> & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 Orthodontist Allegheny<br />

Pryor Leroy 002117 Katsur <strong>Dental</strong> & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 General <strong>Provider</strong> Allegheny<br />

Rinchuse Dara 002117 Katsur <strong>Dental</strong> & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 Orthodontist Allegheny<br />

Schmidt Alan 002117 Katsur <strong>Dental</strong> & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 General <strong>Provider</strong> Allegheny<br />

Smiga Ingrid 002117 Katsur <strong>Dental</strong> & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 General <strong>Provider</strong> Allegheny<br />

Stein Mark 002117 Katsur <strong>Dental</strong> & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 General <strong>Provider</strong> Allegheny<br />

Zalakar Frank 002117 Katsur <strong>Dental</strong> & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 General <strong>Provider</strong> Allegheny<br />

Bonczek Brian 051012 Aspen <strong>Dental</strong> 240 Waterfront Dr E Homestead PA 15120 General <strong>Provider</strong> Allegheny<br />

Ciarallo Robert 051012 Aspen <strong>Dental</strong> 240 Waterfront Dr E Homestead PA 15120 Oral Surgeon Allegheny<br />

Grinberg Anna 051012 Aspen <strong>Dental</strong> 240 Waterfront Dr E Homestead PA 15120 General <strong>Provider</strong> Allegheny<br />

Monaco Natalie 051012 Aspen <strong>Dental</strong> 240 Waterfront Dr E Homestead PA 15120 General <strong>Provider</strong> Allegheny<br />

Ruprecht Heather 051012 Aspen <strong>Dental</strong> 240 Waterfront Dr E Homestead PA 15120 General <strong>Provider</strong> Allegheny<br />

Shieh Andy 051012 Aspen <strong>Dental</strong> 240 Waterfront Dr E Homestead PA 15120 General <strong>Provider</strong> Allegheny<br />

* Indicates dentist that is accepting current patients only.<br />

All <strong>Select</strong> <strong>Plan</strong> Dentists Page 11<br />

1 Same as a DHMO with fixed member copayments, no annual maximum dollar limits, no waiting periods, no deductibles, no pre-authorization paperwork or pre-treatment estimates and no<br />

claim forms or proof of loss (except in the case of out-of-area emergencies). Member must enroll with a General Dentist. Fac ID is used to indicate which facility a member chooses.


SELECT PLAN 1 DENTIST DIRECTORY<br />

Dentists listed are under contract as of 10/1/12<br />

Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />

Schwimer Charles 001822 Charles W. Schwimer, D.M.D. 6201 Steubenville Pike Mc Kees Rocks PA 15136 Periodontist Allegheny<br />

Wintner Morton 001750 Morton S. Wintner, D.M.D. 6000 Steubenville Pike Mc Kees Rocks PA 15136 Orthodontist Allegheny<br />

Adams William 001077 Katsur <strong>Dental</strong> & Orthodontics 820 Fifth Avenue Mc Keesport PA 15132 General <strong>Provider</strong> Allegheny<br />

Affolter John 001077 Katsur <strong>Dental</strong> & Orthodontics 820 Fifth Avenue Mc Keesport PA 15132 General <strong>Provider</strong> Allegheny<br />

Alagirisamy Kiruthika 001077 Katsur <strong>Dental</strong> & Orthodontics 820 Fifth Avenue Mc Keesport PA 15132 General <strong>Provider</strong> Allegheny<br />

Carozza Roselyn 001077 Katsur <strong>Dental</strong> & Orthodontics 820 Fifth Avenue Mc Keesport PA 15132 General <strong>Provider</strong> Allegheny<br />

Cohen Ira 001077 Katsur <strong>Dental</strong> & Orthodontics 820 Fifth Avenue Mc Keesport PA 15132 General <strong>Provider</strong> Allegheny<br />

Dahar Nicholas 001077 Katsur <strong>Dental</strong> & Orthodontics 820 Fifth Avenue Mc Keesport PA 15132 Orthodontist Allegheny<br />

Damich Louis 001077 Katsur <strong>Dental</strong> & Orthodontics 820 Fifth Avenue Mc Keesport PA 15132 General <strong>Provider</strong> Allegheny<br />

Ghaffari Catherine 001077 Katsur <strong>Dental</strong> & Orthodontics 820 Fifth Avenue Mc Keesport PA 15132 General <strong>Provider</strong> Allegheny<br />

Ghajarnia M. Reza 001077 Katsur <strong>Dental</strong> & Orthodontics 820 Fifth Avenue Mc Keesport PA 15132 Orthodontist Allegheny<br />

Gillen Steve 001077 Katsur <strong>Dental</strong> & Orthodontics 820 Fifth Avenue Mc Keesport PA 15132 General <strong>Provider</strong> Allegheny<br />

Iszkula Steven 001077 Katsur <strong>Dental</strong> & Orthodontics 820 Fifth Avenue Mc Keesport PA 15132 Orthodontist Allegheny<br />

Katsur James 001077 Katsur <strong>Dental</strong> & Orthodontics 820 Fifth Avenue Mc Keesport PA 15132 General <strong>Provider</strong> Allegheny<br />

Khurana Leena 001077 Katsur <strong>Dental</strong> & Orthodontics 820 Fifth Avenue Mc Keesport PA 15132 General <strong>Provider</strong> Allegheny<br />

Kier Calvin 001077 Katsur <strong>Dental</strong> & Orthodontics 820 Fifth Avenue Mc Keesport PA 15132 General <strong>Provider</strong> Allegheny<br />

King David 001077 Katsur <strong>Dental</strong> & Orthodontics 820 Fifth Avenue Mc Keesport PA 15132 Orthodontist Allegheny<br />

Kolla Siva 001077 Katsur <strong>Dental</strong> & Orthodontics 820 Fifth Avenue Mc Keesport PA 15132 General <strong>Provider</strong> Allegheny<br />

Lewis Howell 001077 Katsur <strong>Dental</strong> & Orthodontics 820 Fifth Avenue Mc Keesport PA 15132 Orthodontist Allegheny<br />

Miller Van 001077 Katsur <strong>Dental</strong> & Orthodontics 820 Fifth Avenue Mc Keesport PA 15132 Orthodontist Allegheny<br />

Pryor Leroy 001077 Katsur <strong>Dental</strong> & Orthodontics 820 Fifth Avenue Mc Keesport PA 15132 General <strong>Provider</strong> Allegheny<br />

Rinchuse Dara 001077 Katsur <strong>Dental</strong> & Orthodontics 820 Fifth Avenue Mc Keesport PA 15132 Orthodontist Allegheny<br />

Schmidt Alan 001077 Katsur <strong>Dental</strong> & Orthodontics 820 Fifth Avenue Mc Keesport PA 15132 General <strong>Provider</strong> Allegheny<br />

Smiga Ingrid 001077 Katsur <strong>Dental</strong> & Orthodontics 820 Fifth Avenue Mc Keesport PA 15132 General <strong>Provider</strong> Allegheny<br />

Stein Mark 001077 Katsur <strong>Dental</strong> & Orthodontics 820 Fifth Avenue Mc Keesport PA 15132 General <strong>Provider</strong> Allegheny<br />

Tinnemeyer Anjuli 001077 Katsur <strong>Dental</strong> & Orthodontics 820 Fifth Avenue Mc Keesport PA 15132 General <strong>Provider</strong> Allegheny<br />

Zalakar Frank 001077 Katsur <strong>Dental</strong> & Orthodontics 820 Fifth Avenue Mc Keesport PA 15132 General <strong>Provider</strong> Allegheny<br />

Strobel Bradford 001449 Bradford E. Strobel, D.M.D. 5949 Steubenville Pike McKees Rocks PA 15136 General <strong>Provider</strong> Allegheny<br />

Monaco Natalie 050881 McKees Rocks <strong>Dental</strong> 757 Chartiers Ave McKees Rocks PA 15136 General <strong>Provider</strong> Allegheny<br />

Dandashi Moutaz 050690 Katsur <strong>Dental</strong> & Orthodontics Specialists 820 5th Ave McKeesport PA 15132 Pedodontist Allegheny<br />

Hertzler L Gregory 050690 Katsur <strong>Dental</strong> & Orthodontics Specialists 820 5th Ave McKeesport PA 15132 Oral Surgeon Allegheny<br />

Kelly Derek 050690 Katsur <strong>Dental</strong> & Orthodontics Specialists 820 5th Ave McKeesport PA 15132 Oral Surgeon Allegheny<br />

Kier Gregory 050690 Katsur <strong>Dental</strong> & Orthodontics Specialists 820 5th Ave McKeesport PA 15132 Periodontist Allegheny<br />

Monti Richard 050690 Katsur <strong>Dental</strong> & Orthodontics Specialists 820 5th Ave McKeesport PA 15132 Oral Surgeon Allegheny<br />

Ayoub Samir 001364 Samir J. Ayoub, D.M.D. 4304 Walnut Street McKeesport PA 15132 General <strong>Provider</strong> Allegheny<br />

Dargan Monica 001590 Chestnut Hills <strong>Dental</strong> 320 Center Rd. Monroeville PA 15146 General <strong>Provider</strong> Allegheny<br />

DiCristofaro Dean 001590 Chestnut Hills <strong>Dental</strong> 320 Center Rd. Monroeville PA 15146 General <strong>Provider</strong> Allegheny<br />

Gusmerotti Gary 001590 Chestnut Hills <strong>Dental</strong> 320 Center Rd. Monroeville PA 15146 General <strong>Provider</strong> Allegheny<br />

Hudock Robert 001590 Chestnut Hills <strong>Dental</strong> 320 Center Rd. Monroeville PA 15146 General <strong>Provider</strong> Allegheny<br />

Sassouni Anouk 001590 Chestnut Hills <strong>Dental</strong> 320 Center Rd. Monroeville PA 15146 Orthodontist Allegheny<br />

Strezo Kevin 001590 Chestnut Hills <strong>Dental</strong> 320 Center Rd. Monroeville PA 15146 General <strong>Provider</strong> Allegheny<br />

Shensa David 071470 Chestnut Hills <strong>Dental</strong> Specialists 320 Center Rd Monroeville PA 15146 Oral Surgeon Allegheny<br />

Adams William 001074 Katsur <strong>Dental</strong> & Orthodontics 2644 Mosside Blvd. Monroeville PA 15146 General <strong>Provider</strong> Allegheny<br />

Affolter John 001074 Katsur <strong>Dental</strong> & Orthodontics 2644 Mosside Blvd. Monroeville PA 15146 General <strong>Provider</strong> Allegheny<br />

Alagirisamy Kiruthika 001074 Katsur <strong>Dental</strong> & Orthodontics 2644 Mosside Blvd. Monroeville PA 15146 General <strong>Provider</strong> Allegheny<br />

Carozza Roselyn 001074 Katsur <strong>Dental</strong> & Orthodontics 2644 Mosside Blvd. Monroeville PA 15146 General <strong>Provider</strong> Allegheny<br />

Cohen Ira 001074 Katsur <strong>Dental</strong> & Orthodontics 2644 Mosside Blvd. Monroeville PA 15146 General <strong>Provider</strong> Allegheny<br />

Dahar Nicholas 001074 Katsur <strong>Dental</strong> & Orthodontics 2644 Mosside Blvd. Monroeville PA 15146 Orthodontist Allegheny<br />

Damich Louis 001074 Katsur <strong>Dental</strong> & Orthodontics 2644 Mosside Blvd. Monroeville PA 15146 General <strong>Provider</strong> Allegheny<br />

Ghaffari Catherine 001074 Katsur <strong>Dental</strong> & Orthodontics 2644 Mosside Blvd. Monroeville PA 15146 General <strong>Provider</strong> Allegheny<br />

Ghajarnia M. Reza 001074 Katsur <strong>Dental</strong> & Orthodontics 2644 Mosside Blvd. Monroeville PA 15146 Orthodontist Allegheny<br />

Gillen Steve 001074 Katsur <strong>Dental</strong> & Orthodontics 2644 Mosside Blvd. Monroeville PA 15146 General <strong>Provider</strong> Allegheny<br />

Iszkula Steven 001074 Katsur <strong>Dental</strong> & Orthodontics 2644 Mosside Blvd. Monroeville PA 15146 Orthodontist Allegheny<br />

Katsur James 001074 Katsur <strong>Dental</strong> & Orthodontics 2644 Mosside Blvd. Monroeville PA 15146 General <strong>Provider</strong> Allegheny<br />

Khurana Leena 001074 Katsur <strong>Dental</strong> & Orthodontics 2644 Mosside Blvd. Monroeville PA 15146 General <strong>Provider</strong> Allegheny<br />

Kier Calvin 001074 Katsur <strong>Dental</strong> & Orthodontics 2644 Mosside Blvd. Monroeville PA 15146 General <strong>Provider</strong> Allegheny<br />

King David 001074 Katsur <strong>Dental</strong> & Orthodontics 2644 Mosside Blvd. Monroeville PA 15146 Orthodontist Allegheny<br />

Kolla Siva 001074 Katsur <strong>Dental</strong> & Orthodontics 2644 Mosside Blvd. Monroeville PA 15146 General <strong>Provider</strong> Allegheny<br />

Lewis Howell 001074 Katsur <strong>Dental</strong> & Orthodontics 2644 Mosside Blvd. Monroeville PA 15146 Orthodontist Allegheny<br />

Miller Van 001074 Katsur <strong>Dental</strong> & Orthodontics 2644 Mosside Blvd. Monroeville PA 15146 Orthodontist Allegheny<br />

Pryor Leroy 001074 Katsur <strong>Dental</strong> & Orthodontics 2644 Mosside Blvd. Monroeville PA 15146 General <strong>Provider</strong> Allegheny<br />

Rinchuse Dara 001074 Katsur <strong>Dental</strong> & Orthodontics 2644 Mosside Blvd. Monroeville PA 15146 Orthodontist Allegheny<br />

Schmidt Alan 001074 Katsur <strong>Dental</strong> & Orthodontics 2644 Mosside Blvd. Monroeville PA 15146 General <strong>Provider</strong> Allegheny<br />

Smiga Ingrid 001074 Katsur <strong>Dental</strong> & Orthodontics 2644 Mosside Blvd. Monroeville PA 15146 General <strong>Provider</strong> Allegheny<br />

Stein Mark 001074 Katsur <strong>Dental</strong> & Orthodontics 2644 Mosside Blvd. Monroeville PA 15146 General <strong>Provider</strong> Allegheny<br />

Tinnemeyer Anjuli 001074 Katsur <strong>Dental</strong> & Orthodontics 2644 Mosside Blvd. Monroeville PA 15146 General <strong>Provider</strong> Allegheny<br />

* Indicates dentist that is accepting current patients only.<br />

All <strong>Select</strong> <strong>Plan</strong> Dentists Page 12<br />

1 Same as a DHMO with fixed member copayments, no annual maximum dollar limits, no waiting periods, no deductibles, no pre-authorization paperwork or pre-treatment estimates and no<br />

claim forms or proof of loss (except in the case of out-of-area emergencies). Member must enroll with a General Dentist. Fac ID is used to indicate which facility a member chooses.


SELECT PLAN 1 DENTIST DIRECTORY<br />

Dentists listed are under contract as of 10/1/12<br />

Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />

Zalakar Frank 001074 Katsur <strong>Dental</strong> & Orthodontics 2644 Mosside Blvd. Monroeville PA 15146 General <strong>Provider</strong> Allegheny<br />

Dandashi Moutaz 050692 Katsur <strong>Dental</strong> & Orthodontics Specialists 2644 Mosside Blvd Monroeville PA 15146 Pedodontist Allegheny<br />

Hertzler L Gregory 050692 Katsur <strong>Dental</strong> & Orthodontics Specialists 2644 Mosside Blvd Monroeville PA 15146 Oral Surgeon Allegheny<br />

Kelly Derek 050692 Katsur <strong>Dental</strong> & Orthodontics Specialists 2644 Mosside Blvd Monroeville PA 15146 Oral Surgeon Allegheny<br />

Kier Gregory 050692 Katsur <strong>Dental</strong> & Orthodontics Specialists 2644 Mosside Blvd Monroeville PA 15146 Periodontist Allegheny<br />

Monti Richard 050692 Katsur <strong>Dental</strong> & Orthodontics Specialists 2644 Mosside Blvd Monroeville PA 15146 Oral Surgeon Allegheny<br />

Grimes Michael 001804 Michael L. Grimes, D.M.D. 2550 Mosside Blvd., Ste. 213 Monroeville PA 15146 Pedodontist Allegheny<br />

Thomas Arnold 001640 Arnold W. Thomas, D.M.D., P.C. 1000 Commerce Street, Suite 108 Moon Township PA 15108 General <strong>Provider</strong> Allegheny<br />

Skoff David 001432 David M. Skoff, D.M.D., P.C. 850 Beaver Grade Road Moon Township PA 15108 General <strong>Provider</strong> Allegheny<br />

Skoff Joseph 001432 David M. Skoff, D.M.D., P.C. 850 Beaver Grade Road Moon Township PA 15108 General <strong>Provider</strong> Allegheny<br />

Sofranko Kenneth 001509 Kenneth M. Sofranko, D.M.D. 928 Brodhead Road Moon Township PA 15108 General <strong>Provider</strong> Allegheny<br />

Lee Phyllis 070988 Prosthetic Dentistry of Mt Lebanon PC 603 Washington Rd, Suite 200 Mount Lebanon PA 15228 General <strong>Provider</strong> Allegheny<br />

Dunn Stephen 002205 Munhall <strong>Dental</strong> 4101 McWhinney Street Munhall PA 15120 General <strong>Provider</strong> Allegheny<br />

Chernoff Herbert 001245 Herbert Chernoff, D.M.D. 500 Lincoln Hwy. N Versailles PA 15137 General <strong>Provider</strong> Allegheny<br />

Kreashko Robert 002569 Kreashko Orthodontics 1601 Union Ave. Natrona Heights PA 15065 Orthodontist Allegheny<br />

Adams William 001071 Katsur <strong>Dental</strong> & Orthodontics 1955 Wharton St. Pittsburgh PA 15203 General <strong>Provider</strong> Allegheny<br />

Affolter John 001071 Katsur <strong>Dental</strong> & Orthodontics 1955 Wharton St. Pittsburgh PA 15203 General <strong>Provider</strong> Allegheny<br />

Alagirisamy Kiruthika 001071 Katsur <strong>Dental</strong> & Orthodontics 1955 Wharton St. Pittsburgh PA 15203 General <strong>Provider</strong> Allegheny<br />

Carozza Roselyn 001071 Katsur <strong>Dental</strong> & Orthodontics 1955 Wharton St. Pittsburgh PA 15203 General <strong>Provider</strong> Allegheny<br />

Cohen Ira 001071 Katsur <strong>Dental</strong> & Orthodontics 1955 Wharton St. Pittsburgh PA 15203 General <strong>Provider</strong> Allegheny<br />

Dahar Nicholas 001071 Katsur <strong>Dental</strong> & Orthodontics 1955 Wharton St. Pittsburgh PA 15203 Orthodontist Allegheny<br />

Damich Louis 001071 Katsur <strong>Dental</strong> & Orthodontics 1955 Wharton St. Pittsburgh PA 15203 General <strong>Provider</strong> Allegheny<br />

Ghaffari Catherine 001071 Katsur <strong>Dental</strong> & Orthodontics 1955 Wharton St. Pittsburgh PA 15203 General <strong>Provider</strong> Allegheny<br />

Ghajarnia M. Reza 001071 Katsur <strong>Dental</strong> & Orthodontics 1955 Wharton St. Pittsburgh PA 15203 Orthodontist Allegheny<br />

Gillen Steve 001071 Katsur <strong>Dental</strong> & Orthodontics 1955 Wharton St. Pittsburgh PA 15203 General <strong>Provider</strong> Allegheny<br />

Iszkula Steven 001071 Katsur <strong>Dental</strong> & Orthodontics 1955 Wharton St. Pittsburgh PA 15203 Orthodontist Allegheny<br />

Katsur James 001071 Katsur <strong>Dental</strong> & Orthodontics 1955 Wharton St. Pittsburgh PA 15203 General <strong>Provider</strong> Allegheny<br />

Khurana Leena 001071 Katsur <strong>Dental</strong> & Orthodontics 1955 Wharton St. Pittsburgh PA 15203 General <strong>Provider</strong> Allegheny<br />

Kier Calvin 001071 Katsur <strong>Dental</strong> & Orthodontics 1955 Wharton St. Pittsburgh PA 15203 General <strong>Provider</strong> Allegheny<br />

King David 001071 Katsur <strong>Dental</strong> & Orthodontics 1955 Wharton St. Pittsburgh PA 15203 Orthodontist Allegheny<br />

Kolla Siva 001071 Katsur <strong>Dental</strong> & Orthodontics 1955 Wharton St. Pittsburgh PA 15203 General <strong>Provider</strong> Allegheny<br />

Lewis Howell 001071 Katsur <strong>Dental</strong> & Orthodontics 1955 Wharton St. Pittsburgh PA 15203 Orthodontist Allegheny<br />

Miller Van 001071 Katsur <strong>Dental</strong> & Orthodontics 1955 Wharton St. Pittsburgh PA 15203 Orthodontist Allegheny<br />

Pryor Leroy 001071 Katsur <strong>Dental</strong> & Orthodontics 1955 Wharton St. Pittsburgh PA 15203 General <strong>Provider</strong> Allegheny<br />

Rinchuse Dara 001071 Katsur <strong>Dental</strong> & Orthodontics 1955 Wharton St. Pittsburgh PA 15203 Orthodontist Allegheny<br />

Schmidt Alan 001071 Katsur <strong>Dental</strong> & Orthodontics 1955 Wharton St. Pittsburgh PA 15203 General <strong>Provider</strong> Allegheny<br />

Smiga Ingrid 001071 Katsur <strong>Dental</strong> & Orthodontics 1955 Wharton St. Pittsburgh PA 15203 General <strong>Provider</strong> Allegheny<br />

Stein Mark 001071 Katsur <strong>Dental</strong> & Orthodontics 1955 Wharton St. Pittsburgh PA 15203 General <strong>Provider</strong> Allegheny<br />

Tinnemeyer Anjuli 001071 Katsur <strong>Dental</strong> & Orthodontics 1955 Wharton St. Pittsburgh PA 15203 General <strong>Provider</strong> Allegheny<br />

Dandashi Moutaz 050694 Katsur <strong>Dental</strong> & Orthodontics Specialists 1955 Wharton St Pittsburgh PA 15203 Pedodontist Allegheny<br />

Hertzler L Gregory 050694 Katsur <strong>Dental</strong> & Orthodontics Specialists 1955 Wharton St Pittsburgh PA 15203 Oral Surgeon Allegheny<br />

Kelly Derek 050694 Katsur <strong>Dental</strong> & Orthodontics Specialists 1955 Wharton St Pittsburgh PA 15203 Oral Surgeon Allegheny<br />

Kier Gregory 050694 Katsur <strong>Dental</strong> & Orthodontics Specialists 1955 Wharton St Pittsburgh PA 15203 Periodontist Allegheny<br />

Monti Richard 050694 Katsur <strong>Dental</strong> & Orthodontics Specialists 1955 Wharton St Pittsburgh PA 15203 Oral Surgeon Allegheny<br />

Dunn Stephen 001215 Southside <strong>Dental</strong> 1408 E Carson St. Pittsburgh PA 15203 General <strong>Provider</strong> Allegheny<br />

Aboosi Omar 033697 Aspen <strong>Dental</strong> 5450 Campbells Run Rd. Pittsburgh PA 15205 General <strong>Provider</strong> Allegheny<br />

Grinberg Anna 033697 Aspen <strong>Dental</strong> 5450 Campbells Run Rd. Pittsburgh PA 15205 General <strong>Provider</strong> Allegheny<br />

Owczarzak Timothy 033697 Aspen <strong>Dental</strong> 5450 Campbells Run Rd. Pittsburgh PA 15205 General <strong>Provider</strong> Allegheny<br />

Wood Justin 033697 Aspen <strong>Dental</strong> 5450 Campbells Run Rd. Pittsburgh PA 15205 General <strong>Provider</strong> Allegheny<br />

Lipp Timothy 001538 C. Timothy Lipp, D.M.D. 1 Robinson Plaza, Suite 160 Pittsburgh PA 15205 General <strong>Provider</strong> Allegheny<br />

Emmert Richard 001489 Emmert <strong>Dental</strong> Associates, P.C. 1730 Settlers Ridge Center Dr Pittsburgh PA 15205 General <strong>Provider</strong> Allegheny<br />

Bott Robert 001227 Robert P. Bott, D.M.D. 4245 Stuebenville Pk. Pittsburgh PA 15205 General <strong>Provider</strong> Allegheny<br />

Josephson Gerald 001542 Gerald M. Josephson, D.M.D. 5850 Centre Avenue Pittsburgh PA 15206 General <strong>Provider</strong> Allegheny<br />

* Hays Maria 001639 Kalson, Marcus, Hays & Associates, P.C. 579 Alger Street Pittsburgh PA 15207 General <strong>Provider</strong> Allegheny<br />

* Marcus Stanley 001639 Kalson, Marcus, Hays & Associates, P.C. 579 Alger Street Pittsburgh PA 15207 General <strong>Provider</strong> Allegheny<br />

Dunn Stephen 000993 Mount Oliver <strong>Dental</strong> Pavillion 145 Brownsville Road Pittsburgh PA 15210 General <strong>Provider</strong> Allegheny<br />

Rohm Constance 002185 Constance Rohm, D.M.D. 1850 Kleber Street Pittsburgh PA 15212 General <strong>Provider</strong> Allegheny<br />

Davis MaryAnn 061293 Steel City <strong>Dental</strong> Associates LLC 3808 Brighton Rd Pittsburgh PA 15212 General <strong>Provider</strong> Allegheny<br />

Monda Thomas 001515 Thomas A. Monda, D.M.D. 1850 Kleber Street Pittsburgh PA 15212 General <strong>Provider</strong> Allegheny<br />

Aboosi Omar 002833 Aspen <strong>Dental</strong> Associates of Western PA PC 4815 Centre Ave., Suite 105 Pittsburgh PA 15213 General <strong>Provider</strong> Allegheny<br />

Bajaj Smriti 002833 Aspen <strong>Dental</strong> Associates of Western PA PC 4815 Centre Ave., Suite 105 Pittsburgh PA 15213 General <strong>Provider</strong> Allegheny<br />

Barber Timothy 002833 Aspen <strong>Dental</strong> Associates of Western PA PC 4815 Centre Ave., Suite 105 Pittsburgh PA 15213 General <strong>Provider</strong> Allegheny<br />

Bonczek Brian 002833 Aspen <strong>Dental</strong> Associates of Western PA PC 4815 Centre Ave., Suite 105 Pittsburgh PA 15213 General <strong>Provider</strong> Allegheny<br />

Budhiraj Anisha 002833 Aspen <strong>Dental</strong> Associates of Western PA PC 4815 Centre Ave., Suite 105 Pittsburgh PA 15213 General <strong>Provider</strong> Allegheny<br />

Ciarallo Robert 002833 Aspen <strong>Dental</strong> Associates of Western PA PC 4815 Centre Ave., Suite 105 Pittsburgh PA 15213 Oral Surgeon Allegheny<br />

Fnu Snigdha 002833 Aspen <strong>Dental</strong> Associates of Western PA PC 4815 Centre Ave., Suite 105 Pittsburgh PA 15213 General <strong>Provider</strong> Allegheny<br />

* Indicates dentist that is accepting current patients only.<br />

All <strong>Select</strong> <strong>Plan</strong> Dentists Page 13<br />

1 Same as a DHMO with fixed member copayments, no annual maximum dollar limits, no waiting periods, no deductibles, no pre-authorization paperwork or pre-treatment estimates and no<br />

claim forms or proof of loss (except in the case of out-of-area emergencies). Member must enroll with a General Dentist. Fac ID is used to indicate which facility a member chooses.


SELECT PLAN 1 DENTIST DIRECTORY<br />

Dentists listed are under contract as of 10/1/12<br />

Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />

Ginde Mayura 002833 Aspen <strong>Dental</strong> Associates of Western PA PC 4815 Centre Ave., Suite 105 Pittsburgh PA 15213 General <strong>Provider</strong> Allegheny<br />

Grinberg Anna 002833 Aspen <strong>Dental</strong> Associates of Western PA PC 4815 Centre Ave., Suite 105 Pittsburgh PA 15213 General <strong>Provider</strong> Allegheny<br />

Khalil Mirette 002833 Aspen <strong>Dental</strong> Associates of Western PA PC 4815 Centre Ave., Suite 105 Pittsburgh PA 15213 General <strong>Provider</strong> Allegheny<br />

Liska Emily 002833 Aspen <strong>Dental</strong> Associates of Western PA PC 4815 Centre Ave., Suite 105 Pittsburgh PA 15213 General <strong>Provider</strong> Allegheny<br />

Masown Surinder 002833 Aspen <strong>Dental</strong> Associates of Western PA PC 4815 Centre Ave., Suite 105 Pittsburgh PA 15213 General <strong>Provider</strong> Allegheny<br />

Poleski Kenneth 002833 Aspen <strong>Dental</strong> Associates of Western PA PC 4815 Centre Ave., Suite 105 Pittsburgh PA 15213 General <strong>Provider</strong> Allegheny<br />

Ruprecht Heather 002833 Aspen <strong>Dental</strong> Associates of Western PA PC 4815 Centre Ave., Suite 105 Pittsburgh PA 15213 General <strong>Provider</strong> Allegheny<br />

Saba Christopher 002833 Aspen <strong>Dental</strong> Associates of Western PA PC 4815 Centre Ave., Suite 105 Pittsburgh PA 15213 General <strong>Provider</strong> Allegheny<br />

Smith Christine 002833 Aspen <strong>Dental</strong> Associates of Western PA PC 4815 Centre Ave., Suite 105 Pittsburgh PA 15213 General <strong>Provider</strong> Allegheny<br />

Wood Justin 002833 Aspen <strong>Dental</strong> Associates of Western PA PC 4815 Centre Ave., Suite 105 Pittsburgh PA 15213 General <strong>Provider</strong> Allegheny<br />

Jeffries Darlene 002217 Jeffries, Smith & Associates, P.C. 4929 Centre Avenue Pittsburgh PA 15213 General <strong>Provider</strong> Allegheny<br />

Parker Bruce 001619 Bruce Parker, D.M.D. 6301 Forbes Avenue, Suite 102 Pittsburgh PA 15217 General <strong>Provider</strong> Allegheny<br />

Runco Clinton 001217 Clinton W. Runco, D.M.D. 6300 Forward Ave. Pittsburgh PA 15217 General <strong>Provider</strong> Allegheny<br />

Dash Marvin 050409 Marvin A Dash DMD <strong>Inc</strong> 6301 Forbes Ave, Suite 230 Pittsburgh PA 15217 Oral Surgeon Allegheny<br />

Blinky David 001212 David G. Blinky, D.M.D., P.C. 7417 Irvine Ave. Pittsburgh PA 15218 General <strong>Provider</strong> Allegheny<br />

Demoise Michael 001212 David G. Blinky, D.M.D., P.C. 7417 Irvine Ave. Pittsburgh PA 15218 General <strong>Provider</strong> Allegheny<br />

Affolter John 002116 Katsur <strong>Dental</strong> & Orthodontics 1631 South Braddock Avenue Pittsburgh PA 15218 General <strong>Provider</strong> Allegheny<br />

Alagirisamy Kiruthika 033971 Katsur <strong>Dental</strong> & Orthodontics 1631 S Braddock Ave Pittsburgh PA 15218 General <strong>Provider</strong> Allegheny<br />

Carozza Roselyn 002116 Katsur <strong>Dental</strong> & Orthodontics 1631 South Braddock Avenue Pittsburgh PA 15218 General <strong>Provider</strong> Allegheny<br />

Cohen Ira 002116 Katsur <strong>Dental</strong> & Orthodontics 1631 South Braddock Avenue Pittsburgh PA 15218 General <strong>Provider</strong> Allegheny<br />

Dahar Nicholas 033971 Katsur <strong>Dental</strong> & Orthodontics 1631 S Braddock Ave Pittsburgh PA 15218 Orthodontist Allegheny<br />

Damich Louis 002116 Katsur <strong>Dental</strong> & Orthodontics 1631 South Braddock Avenue Pittsburgh PA 15218 General <strong>Provider</strong> Allegheny<br />

Dandashi Moutaz 002116 Katsur <strong>Dental</strong> & Orthodontics 1631 South Braddock Avenue Pittsburgh PA 15218 Pedodontist Allegheny<br />

Ghaffari Catherine 002116 Katsur <strong>Dental</strong> & Orthodontics 1631 South Braddock Avenue Pittsburgh PA 15218 General <strong>Provider</strong> Allegheny<br />

Ghajarnia M. Reza 002116 Katsur <strong>Dental</strong> & Orthodontics 1631 South Braddock Avenue Pittsburgh PA 15218 Orthodontist Allegheny<br />

Gillen Steve 002116 Katsur <strong>Dental</strong> & Orthodontics 1631 South Braddock Avenue Pittsburgh PA 15218 General <strong>Provider</strong> Allegheny<br />

Hertzler L Gregory 002116 Katsur <strong>Dental</strong> & Orthodontics 1631 South Braddock Avenue Pittsburgh PA 15218 Oral Surgeon Allegheny<br />

Iszkula Steven 002116 Katsur <strong>Dental</strong> & Orthodontics 1631 South Braddock Avenue Pittsburgh PA 15218 Orthodontist Allegheny<br />

Katsur James 002116 Katsur <strong>Dental</strong> & Orthodontics 1631 South Braddock Avenue Pittsburgh PA 15218 General <strong>Provider</strong> Allegheny<br />

Kelly Derek 002116 Katsur <strong>Dental</strong> & Orthodontics 1631 South Braddock Avenue Pittsburgh PA 15218 Oral Surgeon Allegheny<br />

Khurana Leena 002116 Katsur <strong>Dental</strong> & Orthodontics 1631 South Braddock Avenue Pittsburgh PA 15218 General <strong>Provider</strong> Allegheny<br />

Kier Calvin 002116 Katsur <strong>Dental</strong> & Orthodontics 1631 South Braddock Avenue Pittsburgh PA 15218 General <strong>Provider</strong> Allegheny<br />

Kier Gregory 002116 Katsur <strong>Dental</strong> & Orthodontics 1631 South Braddock Avenue Pittsburgh PA 15218 Periodontist Allegheny<br />

King David 002116 Katsur <strong>Dental</strong> & Orthodontics 1631 South Braddock Avenue Pittsburgh PA 15218 Orthodontist Allegheny<br />

Kolla Siva 033971 Katsur <strong>Dental</strong> & Orthodontics 1631 S Braddock Ave Pittsburgh PA 15218 General <strong>Provider</strong> Allegheny<br />

Lewis Howell 002116 Katsur <strong>Dental</strong> & Orthodontics 1631 South Braddock Avenue Pittsburgh PA 15218 Orthodontist Allegheny<br />

Miller Van 002116 Katsur <strong>Dental</strong> & Orthodontics 1631 South Braddock Avenue Pittsburgh PA 15218 Orthodontist Allegheny<br />

Monti Richard 002116 Katsur <strong>Dental</strong> & Orthodontics 1631 South Braddock Avenue Pittsburgh PA 15218 Oral Surgeon Allegheny<br />

Pryor Leroy 033971 Katsur <strong>Dental</strong> & Orthodontics 1631 S Braddock Ave Pittsburgh PA 15218 General <strong>Provider</strong> Allegheny<br />

Pryor Leroy 002116 Katsur <strong>Dental</strong> & Orthodontics 1631 South Braddock Avenue Pittsburgh PA 15218 General <strong>Provider</strong> Allegheny<br />

Rinchuse Dara 002116 Katsur <strong>Dental</strong> & Orthodontics 1631 South Braddock Avenue Pittsburgh PA 15218 Orthodontist Allegheny<br />

Schmidt Alan 002116 Katsur <strong>Dental</strong> & Orthodontics 1631 South Braddock Avenue Pittsburgh PA 15218 General <strong>Provider</strong> Allegheny<br />

Smiga Ingrid 002116 Katsur <strong>Dental</strong> & Orthodontics 1631 South Braddock Avenue Pittsburgh PA 15218 General <strong>Provider</strong> Allegheny<br />

Stein Mark 033971 Katsur <strong>Dental</strong> & Orthodontics 1631 S Braddock Ave Pittsburgh PA 15218 General <strong>Provider</strong> Allegheny<br />

Tinnemeyer Anjuli 002116 Katsur <strong>Dental</strong> & Orthodontics 1631 South Braddock Avenue Pittsburgh PA 15218 General <strong>Provider</strong> Allegheny<br />

Zalakar Frank 002116 Katsur <strong>Dental</strong> & Orthodontics 1631 South Braddock Avenue Pittsburgh PA 15218 General <strong>Provider</strong> Allegheny<br />

Certo Joseph 001225 Joseph S. Certo DMD, LLC 1350 Locust St, 307 Pittsburgh PA 15219 General <strong>Provider</strong> Allegheny<br />

* Hays Maria 001638 Marcus, Hays & Associates, P.C. Chatham Tower, Suite 1-D Pittsburgh PA 15219 General <strong>Provider</strong> Allegheny<br />

* Marcus Stanley 001638 Marcus, Hays & Associates, P.C. Chatham Tower, Suite 1-D Pittsburgh PA 15219 General <strong>Provider</strong> Allegheny<br />

Palmer Mark 001572 Palmer Family Dentistry 1910 Cochran Road Pittsburgh PA 15220 General <strong>Provider</strong> Allegheny<br />

Snow Russell 035090 Russell B Snow DMD 21 Yost Boulevard, Suite 201 Pittsburgh PA 15221 General <strong>Provider</strong> Allegheny<br />

Emmert Richard 001488 Emmert <strong>Dental</strong> Associates, P.C. 433 Market Square Pittsburgh PA 15222 General <strong>Provider</strong> Allegheny<br />

Dash Marvin 050408 Marvin A Dash DMD <strong>Inc</strong> 355 5th Ave Park Bldg, Suite 1306 Pittsburgh PA 15222 Oral Surgeon Allegheny<br />

King Spencer 001213 Spencer T. King, D.D.S. & Associates 239 Fourth Ave, Suite 403 Pittsburgh PA 15222 General <strong>Provider</strong> Allegheny<br />

Aboosi Omar 002659 Aspen <strong>Dental</strong> Associates of Western PA PC 306 Towne Square Way Pittsburgh PA 15227 General <strong>Provider</strong> Allegheny<br />

Bajaj Smriti 002659 Aspen <strong>Dental</strong> Associates of Western PA PC 306 Towne Square Way Pittsburgh PA 15227 General <strong>Provider</strong> Allegheny<br />

Barber Timothy 002659 Aspen <strong>Dental</strong> Associates of Western PA PC 306 Towne Square Way Pittsburgh PA 15227 General <strong>Provider</strong> Allegheny<br />

Bonczek Brian 002659 Aspen <strong>Dental</strong> Associates of Western PA PC 306 Towne Square Way Pittsburgh PA 15227 General <strong>Provider</strong> Allegheny<br />

Budhiraj Anisha 002659 Aspen <strong>Dental</strong> Associates of Western PA PC 306 Towne Square Way Pittsburgh PA 15227 General <strong>Provider</strong> Allegheny<br />

Ciarallo Robert 002659 Aspen <strong>Dental</strong> Associates of Western PA PC 306 Towne Square Way Pittsburgh PA 15227 Oral Surgeon Allegheny<br />

Fnu Snigdha 002659 Aspen <strong>Dental</strong> Associates of Western PA PC 306 Towne Square Way Pittsburgh PA 15227 General <strong>Provider</strong> Allegheny<br />

Ginde Mayura 002659 Aspen <strong>Dental</strong> Associates of Western PA PC 306 Towne Square Way Pittsburgh PA 15227 General <strong>Provider</strong> Allegheny<br />

Grinberg Anna 002659 Aspen <strong>Dental</strong> Associates of Western PA PC 306 Towne Square Way Pittsburgh PA 15227 General <strong>Provider</strong> Allegheny<br />

Hamati Isam 002659 Aspen <strong>Dental</strong> Associates of Western PA PC 306 Towne Square Way Pittsburgh PA 15227 General <strong>Provider</strong> Allegheny<br />

Khalil Mirette 002659 Aspen <strong>Dental</strong> Associates of Western PA PC 306 Towne Square Way Pittsburgh PA 15227 General <strong>Provider</strong> Allegheny<br />

Liska Emily 002659 Aspen <strong>Dental</strong> Associates of Western PA PC 306 Towne Square Way Pittsburgh PA 15227 General <strong>Provider</strong> Allegheny<br />

* Indicates dentist that is accepting current patients only.<br />

All <strong>Select</strong> <strong>Plan</strong> Dentists Page 14<br />

1 Same as a DHMO with fixed member copayments, no annual maximum dollar limits, no waiting periods, no deductibles, no pre-authorization paperwork or pre-treatment estimates and no<br />

claim forms or proof of loss (except in the case of out-of-area emergencies). Member must enroll with a General Dentist. Fac ID is used to indicate which facility a member chooses.


SELECT PLAN 1 DENTIST DIRECTORY<br />

Dentists listed are under contract as of 10/1/12<br />

Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />

Masown Surinder 002659 Aspen <strong>Dental</strong> Associates of Western PA PC 306 Towne Square Way Pittsburgh PA 15227 General <strong>Provider</strong> Allegheny<br />

Poleski Kenneth 002659 Aspen <strong>Dental</strong> Associates of Western PA PC 306 Towne Square Way Pittsburgh PA 15227 General <strong>Provider</strong> Allegheny<br />

Ruprecht Heather 002659 Aspen <strong>Dental</strong> Associates of Western PA PC 306 Towne Square Way Pittsburgh PA 15227 General <strong>Provider</strong> Allegheny<br />

Saba Christopher 002659 Aspen <strong>Dental</strong> Associates of Western PA PC 306 Towne Square Way Pittsburgh PA 15227 General <strong>Provider</strong> Allegheny<br />

Smith Christine 002659 Aspen <strong>Dental</strong> Associates of Western PA PC 306 Towne Square Way Pittsburgh PA 15227 General <strong>Provider</strong> Allegheny<br />

Wood Justin 002659 Aspen <strong>Dental</strong> Associates of Western PA PC 306 Towne Square Way Pittsburgh PA 15227 General <strong>Provider</strong> Allegheny<br />

Gans Michael 001490 Michael J. Gans, D.M.D. 1699 Washington Road Pittsburgh PA 15228 General <strong>Provider</strong> Allegheny<br />

Pasqual Harry 001249 Pasqual Associates 603 Washington Rd. Pittsburgh PA 15228 Oral Surgeon Allegheny<br />

Sassouni Anouk 001589 Sassouni Orthodontics 607 Washington Road Pittsburgh PA 15228 Orthodontist Allegheny<br />

Cohen Bruce 001211 Family <strong>Dental</strong> Care 344 Center Ave., West View Pittsburgh PA 15229 General <strong>Provider</strong> Allegheny<br />

Adams William 001076 Katsur <strong>Dental</strong> & Orthodontics 1004 West View Park Dr. Pittsburgh PA 15229 General <strong>Provider</strong> Allegheny<br />

Affolter John 001076 Katsur <strong>Dental</strong> & Orthodontics 1004 West View Park Dr. Pittsburgh PA 15229 General <strong>Provider</strong> Allegheny<br />

Alagirisamy Kiruthika 001076 Katsur <strong>Dental</strong> & Orthodontics 1004 West View Park Dr. Pittsburgh PA 15229 General <strong>Provider</strong> Allegheny<br />

Carozza Roselyn 001076 Katsur <strong>Dental</strong> & Orthodontics 1004 West View Park Dr. Pittsburgh PA 15229 General <strong>Provider</strong> Allegheny<br />

Cohen Ira 001076 Katsur <strong>Dental</strong> & Orthodontics 1004 West View Park Dr. Pittsburgh PA 15229 General <strong>Provider</strong> Allegheny<br />

Dahar Nicholas 001076 Katsur <strong>Dental</strong> & Orthodontics 1004 West View Park Dr. Pittsburgh PA 15229 Orthodontist Allegheny<br />

Damich Louis 001076 Katsur <strong>Dental</strong> & Orthodontics 1004 West View Park Dr. Pittsburgh PA 15229 General <strong>Provider</strong> Allegheny<br />

Ghaffari Catherine 001076 Katsur <strong>Dental</strong> & Orthodontics 1004 West View Park Dr. Pittsburgh PA 15229 General <strong>Provider</strong> Allegheny<br />

Ghajarnia M. Reza 001076 Katsur <strong>Dental</strong> & Orthodontics 1004 West View Park Dr. Pittsburgh PA 15229 Orthodontist Allegheny<br />

Gillen Steve 001076 Katsur <strong>Dental</strong> & Orthodontics 1004 West View Park Dr. Pittsburgh PA 15229 General <strong>Provider</strong> Allegheny<br />

Iszkula Steven 001076 Katsur <strong>Dental</strong> & Orthodontics 1004 West View Park Dr. Pittsburgh PA 15229 Orthodontist Allegheny<br />

Katsur James 001076 Katsur <strong>Dental</strong> & Orthodontics 1004 West View Park Dr. Pittsburgh PA 15229 General <strong>Provider</strong> Allegheny<br />

Khurana Leena 001076 Katsur <strong>Dental</strong> & Orthodontics 1004 West View Park Dr. Pittsburgh PA 15229 General <strong>Provider</strong> Allegheny<br />

Kier Calvin 001076 Katsur <strong>Dental</strong> & Orthodontics 1004 West View Park Dr. Pittsburgh PA 15229 General <strong>Provider</strong> Allegheny<br />

King David 001076 Katsur <strong>Dental</strong> & Orthodontics 1004 West View Park Dr. Pittsburgh PA 15229 Orthodontist Allegheny<br />

Kolla Siva 001076 Katsur <strong>Dental</strong> & Orthodontics 1004 West View Park Dr. Pittsburgh PA 15229 General <strong>Provider</strong> Allegheny<br />

Lewis Howell 001076 Katsur <strong>Dental</strong> & Orthodontics 1004 West View Park Dr. Pittsburgh PA 15229 Orthodontist Allegheny<br />

Miller Van 001076 Katsur <strong>Dental</strong> & Orthodontics 1004 West View Park Dr. Pittsburgh PA 15229 Orthodontist Allegheny<br />

Pryor Leroy 001076 Katsur <strong>Dental</strong> & Orthodontics 1004 West View Park Dr. Pittsburgh PA 15229 General <strong>Provider</strong> Allegheny<br />

Rinchuse Dara 001076 Katsur <strong>Dental</strong> & Orthodontics 1004 West View Park Dr. Pittsburgh PA 15229 Orthodontist Allegheny<br />

Schmidt Alan 001076 Katsur <strong>Dental</strong> & Orthodontics 1004 West View Park Dr. Pittsburgh PA 15229 General <strong>Provider</strong> Allegheny<br />

Smiga Ingrid 001076 Katsur <strong>Dental</strong> & Orthodontics 1004 West View Park Dr. Pittsburgh PA 15229 General <strong>Provider</strong> Allegheny<br />

Stein Mark 001076 Katsur <strong>Dental</strong> & Orthodontics 1004 West View Park Dr. Pittsburgh PA 15229 General <strong>Provider</strong> Allegheny<br />

Tinnemeyer Anjuli 001076 Katsur <strong>Dental</strong> & Orthodontics 1004 West View Park Dr. Pittsburgh PA 15229 General <strong>Provider</strong> Allegheny<br />

Zalakar Frank 001076 Katsur <strong>Dental</strong> & Orthodontics 1004 West View Park Dr. Pittsburgh PA 15229 General <strong>Provider</strong> Allegheny<br />

Dandashi Moutaz 050687 Katsur <strong>Dental</strong> & Orthodontics Specialists 1004 W View Park Dr Pittsburgh PA 15229 Pedodontist Allegheny<br />

Hertzler L Gregory 050687 Katsur <strong>Dental</strong> & Orthodontics Specialists 1004 W View Park Dr Pittsburgh PA 15229 Oral Surgeon Allegheny<br />

Kelly Derek 050687 Katsur <strong>Dental</strong> & Orthodontics Specialists 1004 W View Park Dr Pittsburgh PA 15229 Oral Surgeon Allegheny<br />

Kier Gregory 050687 Katsur <strong>Dental</strong> & Orthodontics Specialists 1004 W View Park Dr Pittsburgh PA 15229 Periodontist Allegheny<br />

Monti Richard 050687 Katsur <strong>Dental</strong> & Orthodontics Specialists 1004 W View Park Dr Pittsburgh PA 15229 Oral Surgeon Allegheny<br />

Check Jennifer 061366 Aspen <strong>Dental</strong> 3459 William Penn Hwy Pittsburgh PA 15235 General <strong>Provider</strong> Allegheny<br />

Ciarallo Robert 061366 Aspen <strong>Dental</strong> 3459 William Penn Hwy Pittsburgh PA 15235 Oral Surgeon Allegheny<br />

Cignetti Scott 061366 Aspen <strong>Dental</strong> 3459 William Penn Hwy Pittsburgh PA 15235 General <strong>Provider</strong> Allegheny<br />

Fazio John 061366 Aspen <strong>Dental</strong> 3459 William Penn Hwy Pittsburgh PA 15235 General <strong>Provider</strong> Allegheny<br />

Ferguson III William 061366 Aspen <strong>Dental</strong> 3459 William Penn Hwy Pittsburgh PA 15235 General <strong>Provider</strong> Allegheny<br />

Grinberg Anna 061366 Aspen <strong>Dental</strong> 3459 William Penn Hwy Pittsburgh PA 15235 General <strong>Provider</strong> Allegheny<br />

Malone Matthew 061366 Aspen <strong>Dental</strong> 3459 William Penn Hwy Pittsburgh PA 15235 General <strong>Provider</strong> Allegheny<br />

McCann Eve 061366 Aspen <strong>Dental</strong> 3459 William Penn Hwy Pittsburgh PA 15235 General <strong>Provider</strong> Allegheny<br />

McClain Kelly 061366 Aspen <strong>Dental</strong> 3459 William Penn Hwy Pittsburgh PA 15235 General <strong>Provider</strong> Allegheny<br />

Monios George 061366 Aspen <strong>Dental</strong> 3459 William Penn Hwy Pittsburgh PA 15235 General <strong>Provider</strong> Allegheny<br />

Raja Nabila 061366 Aspen <strong>Dental</strong> 3459 William Penn Hwy Pittsburgh PA 15235 General <strong>Provider</strong> Allegheny<br />

Somers Mitchell 061366 Aspen <strong>Dental</strong> 3459 William Penn Hwy Pittsburgh PA 15235 General <strong>Provider</strong> Allegheny<br />

Tam Dominic 061366 Aspen <strong>Dental</strong> 3459 William Penn Hwy Pittsburgh PA 15235 General <strong>Provider</strong> Allegheny<br />

Trichtinger John 001226 Trichtinger <strong>Dental</strong>, P.C. 11979 Frankstown Rd. Pittsburgh PA 15235 General <strong>Provider</strong> Allegheny<br />

Aboosi Omar 050445 Aspen <strong>Dental</strong> Associates of Western PA PC 560 Clariton Blvd, Suite 1 Pittsburgh PA 15236 General <strong>Provider</strong> Allegheny<br />

Bajaj Smriti 050445 Aspen <strong>Dental</strong> Associates of Western PA PC 560 Clariton Blvd, Suite 1 Pittsburgh PA 15236 General <strong>Provider</strong> Allegheny<br />

Barber Timothy 050445 Aspen <strong>Dental</strong> Associates of Western PA PC 560 Clariton Blvd, Suite 1 Pittsburgh PA 15236 General <strong>Provider</strong> Allegheny<br />

Bonczek Brian 050445 Aspen <strong>Dental</strong> Associates of Western PA PC 560 Clariton Blvd, Suite 1 Pittsburgh PA 15236 General <strong>Provider</strong> Allegheny<br />

Budhiraj Anisha 050445 Aspen <strong>Dental</strong> Associates of Western PA PC 560 Clariton Blvd, Suite 1 Pittsburgh PA 15236 General <strong>Provider</strong> Allegheny<br />

Ciarallo Robert 050445 Aspen <strong>Dental</strong> Associates of Western PA PC 560 Clariton Blvd, Suite 1 Pittsburgh PA 15236 Oral Surgeon Allegheny<br />

Fnu Snigdha 050445 Aspen <strong>Dental</strong> Associates of Western PA PC 560 Clariton Blvd, Suite 1 Pittsburgh PA 15236 General <strong>Provider</strong> Allegheny<br />

Ginde Mayura 050445 Aspen <strong>Dental</strong> Associates of Western PA PC 560 Clariton Blvd, Suite 1 Pittsburgh PA 15236 General <strong>Provider</strong> Allegheny<br />

Grinberg Anna 050445 Aspen <strong>Dental</strong> Associates of Western PA PC 560 Clariton Blvd, Suite 1 Pittsburgh PA 15236 General <strong>Provider</strong> Allegheny<br />

Khalil Mirette 050445 Aspen <strong>Dental</strong> Associates of Western PA PC 560 Clariton Blvd, Suite 1 Pittsburgh PA 15236 General <strong>Provider</strong> Allegheny<br />

Liska Emily 050445 Aspen <strong>Dental</strong> Associates of Western PA PC 560 Clariton Blvd, Suite 1 Pittsburgh PA 15236 General <strong>Provider</strong> Allegheny<br />

Masown Surinder 050445 Aspen <strong>Dental</strong> Associates of Western PA PC 560 Clariton Blvd, Suite 1 Pittsburgh PA 15236 General <strong>Provider</strong> Allegheny<br />

* Indicates dentist that is accepting current patients only.<br />

All <strong>Select</strong> <strong>Plan</strong> Dentists Page 15<br />

1 Same as a DHMO with fixed member copayments, no annual maximum dollar limits, no waiting periods, no deductibles, no pre-authorization paperwork or pre-treatment estimates and no<br />

claim forms or proof of loss (except in the case of out-of-area emergencies). Member must enroll with a General Dentist. Fac ID is used to indicate which facility a member chooses.


SELECT PLAN 1 DENTIST DIRECTORY<br />

Dentists listed are under contract as of 10/1/12<br />

Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />

Poleski Kenneth 050445 Aspen <strong>Dental</strong> Associates of Western PA PC 560 Clariton Blvd, Suite 1 Pittsburgh PA 15236 General <strong>Provider</strong> Allegheny<br />

Ruprecht Heather 050445 Aspen <strong>Dental</strong> Associates of Western PA PC 560 Clariton Blvd, Suite 1 Pittsburgh PA 15236 General <strong>Provider</strong> Allegheny<br />

Saba Christopher 050445 Aspen <strong>Dental</strong> Associates of Western PA PC 560 Clariton Blvd, Suite 1 Pittsburgh PA 15236 General <strong>Provider</strong> Allegheny<br />

Smith Christine 050445 Aspen <strong>Dental</strong> Associates of Western PA PC 560 Clariton Blvd, Suite 1 Pittsburgh PA 15236 General <strong>Provider</strong> Allegheny<br />

Wood Justin 050445 Aspen <strong>Dental</strong> Associates of Western PA PC 560 Clariton Blvd, Suite 1 Pittsburgh PA 15236 General <strong>Provider</strong> Allegheny<br />

Zora James 001583 Jame R Zora DMD 555 E Bruceton Rd. Pittsburgh PA 15236 General <strong>Provider</strong> Allegheny<br />

Adams William 001080 Katsur <strong>Dental</strong> & Orthodontics 2A Old Clairton Road Pittsburgh PA 15236 General <strong>Provider</strong> Allegheny<br />

Affolter John 001080 Katsur <strong>Dental</strong> & Orthodontics 2A Old Clairton Road Pittsburgh PA 15236 General <strong>Provider</strong> Allegheny<br />

Alagirisamy Kiruthika 001080 Katsur <strong>Dental</strong> & Orthodontics 2A Old Clairton Road Pittsburgh PA 15236 General <strong>Provider</strong> Allegheny<br />

Carozza Roselyn 001080 Katsur <strong>Dental</strong> & Orthodontics 2A Old Clairton Road Pittsburgh PA 15236 General <strong>Provider</strong> Allegheny<br />

Cohen Ira 001080 Katsur <strong>Dental</strong> & Orthodontics 2A Old Clairton Road Pittsburgh PA 15236 General <strong>Provider</strong> Allegheny<br />

Dahar Nicholas 001080 Katsur <strong>Dental</strong> & Orthodontics 2A Old Clairton Road Pittsburgh PA 15236 Orthodontist Allegheny<br />

Damich Louis 001080 Katsur <strong>Dental</strong> & Orthodontics 2A Old Clairton Road Pittsburgh PA 15236 General <strong>Provider</strong> Allegheny<br />

Ghaffari Catherine 001080 Katsur <strong>Dental</strong> & Orthodontics 2A Old Clairton Road Pittsburgh PA 15236 General <strong>Provider</strong> Allegheny<br />

Ghajarnia M. Reza 001080 Katsur <strong>Dental</strong> & Orthodontics 2A Old Clairton Road Pittsburgh PA 15236 Orthodontist Allegheny<br />

Gillen Steve 001080 Katsur <strong>Dental</strong> & Orthodontics 2A Old Clairton Road Pittsburgh PA 15236 General <strong>Provider</strong> Allegheny<br />

Iszkula Steven 001080 Katsur <strong>Dental</strong> & Orthodontics 2A Old Clairton Road Pittsburgh PA 15236 Orthodontist Allegheny<br />

Katsur James 001080 Katsur <strong>Dental</strong> & Orthodontics 2A Old Clairton Road Pittsburgh PA 15236 General <strong>Provider</strong> Allegheny<br />

Khurana Leena 001080 Katsur <strong>Dental</strong> & Orthodontics 2A Old Clairton Road Pittsburgh PA 15236 General <strong>Provider</strong> Allegheny<br />

Kier Calvin 001080 Katsur <strong>Dental</strong> & Orthodontics 2A Old Clairton Road Pittsburgh PA 15236 General <strong>Provider</strong> Allegheny<br />

King David 001080 Katsur <strong>Dental</strong> & Orthodontics 2A Old Clairton Road Pittsburgh PA 15236 Orthodontist Allegheny<br />

Kolla Siva 001080 Katsur <strong>Dental</strong> & Orthodontics 2A Old Clairton Road Pittsburgh PA 15236 General <strong>Provider</strong> Allegheny<br />

Lewis Howell 001080 Katsur <strong>Dental</strong> & Orthodontics 2A Old Clairton Road Pittsburgh PA 15236 Orthodontist Allegheny<br />

Miller Van 001080 Katsur <strong>Dental</strong> & Orthodontics 2A Old Clairton Road Pittsburgh PA 15236 Orthodontist Allegheny<br />

Pryor Leroy 001080 Katsur <strong>Dental</strong> & Orthodontics 2A Old Clairton Road Pittsburgh PA 15236 General <strong>Provider</strong> Allegheny<br />

Rinchuse Dara 001080 Katsur <strong>Dental</strong> & Orthodontics 2A Old Clairton Road Pittsburgh PA 15236 Orthodontist Allegheny<br />

Schmidt Alan 001080 Katsur <strong>Dental</strong> & Orthodontics 2A Old Clairton Road Pittsburgh PA 15236 General <strong>Provider</strong> Allegheny<br />

Smiga Ingrid 001080 Katsur <strong>Dental</strong> & Orthodontics 2A Old Clairton Road Pittsburgh PA 15236 General <strong>Provider</strong> Allegheny<br />

Stein Mark 001080 Katsur <strong>Dental</strong> & Orthodontics 2A Old Clairton Road Pittsburgh PA 15236 General <strong>Provider</strong> Allegheny<br />

Tinnemeyer Anjuli 001080 Katsur <strong>Dental</strong> & Orthodontics 2A Old Clairton Road Pittsburgh PA 15236 General <strong>Provider</strong> Allegheny<br />

Zalakar Frank 001080 Katsur <strong>Dental</strong> & Orthodontics 2A Old Clairton Road Pittsburgh PA 15236 General <strong>Provider</strong> Allegheny<br />

Dandashi Moutaz 050696 Katsur <strong>Dental</strong> & Orthodontics Specialists 2A Old Clariton Rd Pittsburgh PA 15236 Pedodontist Allegheny<br />

Hertzler L Gregory 050696 Katsur <strong>Dental</strong> & Orthodontics Specialists 2A Old Clariton Rd Pittsburgh PA 15236 Oral Surgeon Allegheny<br />

Kelly Derek 050696 Katsur <strong>Dental</strong> & Orthodontics Specialists 2A Old Clariton Rd Pittsburgh PA 15236 Oral Surgeon Allegheny<br />

Kier Gregory 050696 Katsur <strong>Dental</strong> & Orthodontics Specialists 2A Old Clariton Rd Pittsburgh PA 15236 Periodontist Allegheny<br />

Monti Richard 050696 Katsur <strong>Dental</strong> & Orthodontics Specialists 2A Old Clariton Rd Pittsburgh PA 15236 Oral Surgeon Allegheny<br />

Smiga Steven 001235 Steven I. Smiga, D.M.D. 4730 Clairton Blvd. Pittsburgh PA 15236 General <strong>Provider</strong> Allegheny<br />

Aboosi Omar 002884 Aspen <strong>Dental</strong> Associates of NY, PC 7372 B. McKnight Road Pittsburgh PA 15237 General <strong>Provider</strong> Allegheny<br />

Grinberg Anna 002884 Aspen <strong>Dental</strong> Associates of NY, PC 7372 B. McKnight Road Pittsburgh PA 15237 General <strong>Provider</strong> Allegheny<br />

Owczarzak Timothy 002884 Aspen <strong>Dental</strong> Associates of NY, PC 7372 B. McKnight Road Pittsburgh PA 15237 General <strong>Provider</strong> Allegheny<br />

Wood Justin 002884 Aspen <strong>Dental</strong> Associates of NY, PC 7372 B. McKnight Road Pittsburgh PA 15237 General <strong>Provider</strong> Allegheny<br />

Herock Michael 000486 Certus <strong>Dental</strong>Care, LLC 8035 McKnight Road, Ste 201, Andre Plaza Pittsburgh PA 15237 General <strong>Provider</strong> Allegheny<br />

Horvath Kristin 061358 Horvath Family Dentistry 734 West Ingomar Pittsburgh PA 15237 General <strong>Provider</strong> Allegheny<br />

Mikus Mark 001879 Mark A. Mikus Family Dentistry 9400 McKnight Rd., Suite 101 Pittsburgh PA 15237 General <strong>Provider</strong> Allegheny<br />

Miller Richard 001241 Richard Miller, D.M.D. 449 Rochester Rd. Pittsburgh PA 15237 General <strong>Provider</strong> Allegheny<br />

Conquest Matthew 002196 Snyder & Dugan Oral & Maxillofacial Surgery 9401 McKnight Rd, Suite 201 Pittsburgh PA 15237 Oral Surgeon Allegheny<br />

Dugan Michael 002196 Snyder & Dugan Oral & Maxillofacial Surgery 9401 McKnight Rd, Suite 201 Pittsburgh PA 15237 Oral Surgeon Allegheny<br />

Snyder Richard 002196 Snyder & Dugan Oral & Maxillofacial Surgery 9401 McKnight Rd, Suite 201 Pittsburgh PA 15237 Oral Surgeon Allegheny<br />

Sweeney Patrick 002196 Snyder & Dugan Oral & Maxillofacial Surgery 9401 McKnight Rd, Suite 201 Pittsburgh PA 15237 Oral Surgeon Allegheny<br />

Toth Thomas 001437 Thomas M. Toth, D.M.D. 100 McKnight Park Drive, Suite 102 Pittsburgh PA 15237 General <strong>Provider</strong> Allegheny<br />

Sante Richard 001498 Richard A. Sante, Jr., D.M.D. 8075 Saltsburg Rd. Pittsburgh PA 15239 General <strong>Provider</strong> Allegheny<br />

Oakley Marnie 001429 University of Pittsburgh School of <strong>Dental</strong> Medicine 3501 Terrace Street, Salk Hall Pittsburgh PA 15261 General <strong>Provider</strong> Allegheny<br />

Schnieder Lawrence 001429 University of Pittsburgh School of <strong>Dental</strong> Medicine 3501 Terrace Street, Salk Hall Pittsburgh PA 15261 General <strong>Provider</strong> Allegheny<br />

Syling William 002702 Syling and Toth, DMD's 1 Forsythe Rd. Presto PA 15142 General <strong>Provider</strong> Allegheny<br />

Toth Gary 002702 Syling and Toth, DMD's 1 Forsythe Rd. Presto PA 15142 General <strong>Provider</strong> Allegheny<br />

Ciarallo Robert 033835 Aspen <strong>Dental</strong> of Western PA, PC 2031 Pittsburgh Mills Blvd. Tarentum PA 15084 Oral Surgeon Allegheny<br />

Garver Eric 033835 Aspen <strong>Dental</strong> of Western PA, PC 2031 Pittsburgh Mills Blvd. Tarentum PA 15084 General <strong>Provider</strong> Allegheny<br />

Grinberg Anna 033835 Aspen <strong>Dental</strong> of Western PA, PC 2031 Pittsburgh Mills Blvd. Tarentum PA 15084 General <strong>Provider</strong> Allegheny<br />

Laughrey Nathan 033835 Aspen <strong>Dental</strong> of Western PA, PC 2031 Pittsburgh Mills Blvd. Tarentum PA 15084 General <strong>Provider</strong> Allegheny<br />

Ruprecht Heather 033835 Aspen <strong>Dental</strong> of Western PA, PC 2031 Pittsburgh Mills Blvd. Tarentum PA 15084 General <strong>Provider</strong> Allegheny<br />

Manalo Arsenio 001210 Manalo <strong>Dental</strong> & Associates Duquesne Village, 1870 B Homeville Road West Mifflin PA 15122 General <strong>Provider</strong> Allegheny<br />

Grady John 002250 John Marshall Grady DMD Associates LLC 1000 Brooktree Road, Suite 200 Wexford PA 15090 Orthodontist Allegheny<br />

Kastner Dan 002250 John Marshall Grady DMD Associates LLC 1000 Brooktree Road, Suite 200 Wexford PA 15090 Orthodontist Allegheny<br />

Syling William 002701 Syling and Toth, DMD's 107 Whittaker Street Whitaker PA 15120 General <strong>Provider</strong> Allegheny<br />

Toth Gary 002701 Syling and Toth, DMD's 107 Whittaker Street Whitaker PA 15120 General <strong>Provider</strong> Allegheny<br />

Zammerilla Charles 001617 Charles F. Zammerilla, D.M.D. 2110 McLean Aliquippa PA 15001 General <strong>Provider</strong> Beaver<br />

* Indicates dentist that is accepting current patients only.<br />

All <strong>Select</strong> <strong>Plan</strong> Dentists Page 16<br />

1 Same as a DHMO with fixed member copayments, no annual maximum dollar limits, no waiting periods, no deductibles, no pre-authorization paperwork or pre-treatment estimates and no<br />

claim forms or proof of loss (except in the case of out-of-area emergencies). Member must enroll with a General Dentist. Fac ID is used to indicate which facility a member chooses.


SELECT PLAN 1 DENTIST DIRECTORY<br />

Dentists listed are under contract as of 10/1/12<br />

Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />

Brock Larry 001271 Beaver Valley <strong>Dental</strong> LLC 546 Merchant St Ambridge PA 15003 General <strong>Provider</strong> Beaver<br />

Feduska Linda 061409 My Best Smile 1624 State St W Baden PA 15005 General <strong>Provider</strong> Beaver<br />

Kokai John 061409 My Best Smile 1624 State St W Baden PA 15005 General <strong>Provider</strong> Beaver<br />

Lipp Timothy 001352 C. Timothy Lipp, D.M.D. 3315 4th Avenue Beaver Falls PA 15010 General <strong>Provider</strong> Beaver<br />

DiPaul Eric 001612 Primary Health Network/Beaver Falls <strong>Dental</strong> Center 1302 7th Ave Beaver Falls PA 15010 General <strong>Provider</strong> Beaver<br />

Lipscomb Richard 001612 Primary Health Network/Beaver Falls <strong>Dental</strong> Center 1302 7th Ave Beaver Falls PA 15010 General <strong>Provider</strong> Beaver<br />

Aboosi Omar 002859 Aspen <strong>Dental</strong> Associates of Western PA PC 190 Golfview Drive, Centerpoint Shopping Ctr. Monaca PA 15061 General <strong>Provider</strong> Beaver<br />

Bajaj Smriti 002859 Aspen <strong>Dental</strong> Associates of Western PA PC 190 Golfview Drive, Centerpoint Shopping Ctr. Monaca PA 15061 General <strong>Provider</strong> Beaver<br />

Barber Timothy 002859 Aspen <strong>Dental</strong> Associates of Western PA PC 190 Golfview Drive, Centerpoint Shopping Ctr. Monaca PA 15061 General <strong>Provider</strong> Beaver<br />

Bonczek Brian 002859 Aspen <strong>Dental</strong> Associates of Western PA PC 190 Golfview Drive, Centerpoint Shopping Ctr. Monaca PA 15061 General <strong>Provider</strong> Beaver<br />

Budhiraj Anisha 002859 Aspen <strong>Dental</strong> Associates of Western PA PC 190 Golfview Drive, Centerpoint Shopping Ctr. Monaca PA 15061 General <strong>Provider</strong> Beaver<br />

Cahall Anna 002859 Aspen <strong>Dental</strong> Associates of Western PA PC 190 Golfview Drive, Centerpoint Shopping Ctr. Monaca PA 15061 General <strong>Provider</strong> Beaver<br />

Ciarallo Robert 002859 Aspen <strong>Dental</strong> Associates of Western PA PC 190 Golfview Drive, Centerpoint Shopping Ctr. Monaca PA 15061 Oral Surgeon Beaver<br />

Fnu Snigdha 002859 Aspen <strong>Dental</strong> Associates of Western PA PC 190 Golfview Drive, Centerpoint Shopping Ctr. Monaca PA 15061 General <strong>Provider</strong> Beaver<br />

Ginde Mayura 002859 Aspen <strong>Dental</strong> Associates of Western PA PC 190 Golfview Drive, Centerpoint Shopping Ctr. Monaca PA 15061 General <strong>Provider</strong> Beaver<br />

Grinberg Anna 002859 Aspen <strong>Dental</strong> Associates of Western PA PC 190 Golfview Drive, Centerpoint Shopping Ctr. Monaca PA 15061 General <strong>Provider</strong> Beaver<br />

Khalil Mirette 002859 Aspen <strong>Dental</strong> Associates of Western PA PC 190 Golfview Drive, Centerpoint Shopping Ctr. Monaca PA 15061 General <strong>Provider</strong> Beaver<br />

Liska Emily 002859 Aspen <strong>Dental</strong> Associates of Western PA PC 190 Golfview Drive, Centerpoint Shopping Ctr. Monaca PA 15061 General <strong>Provider</strong> Beaver<br />

Masown Surinder 002859 Aspen <strong>Dental</strong> Associates of Western PA PC 190 Golfview Drive, Centerpoint Shopping Ctr. Monaca PA 15061 General <strong>Provider</strong> Beaver<br />

Poleski Kenneth 002859 Aspen <strong>Dental</strong> Associates of Western PA PC 190 Golfview Drive, Centerpoint Shopping Ctr. Monaca PA 15061 General <strong>Provider</strong> Beaver<br />

Ruprecht Heather 002859 Aspen <strong>Dental</strong> Associates of Western PA PC 190 Golfview Drive, Centerpoint Shopping Ctr. Monaca PA 15061 General <strong>Provider</strong> Beaver<br />

Saba Christopher 002859 Aspen <strong>Dental</strong> Associates of Western PA PC 190 Golfview Drive, Centerpoint Shopping Ctr. Monaca PA 15061 General <strong>Provider</strong> Beaver<br />

Smith Christine 002859 Aspen <strong>Dental</strong> Associates of Western PA PC 190 Golfview Drive, Centerpoint Shopping Ctr. Monaca PA 15061 General <strong>Provider</strong> Beaver<br />

Wood Justin 002859 Aspen <strong>Dental</strong> Associates of Western PA PC 190 Golfview Drive, Centerpoint Shopping Ctr. Monaca PA 15061 General <strong>Provider</strong> Beaver<br />

Skoff David 001433 David M. Skoff, D.M.D., P.C. 3532 Brodhead Road Monaca PA 15061 General <strong>Provider</strong> Beaver<br />

Skoff Joseph 001433 David M. Skoff, D.M.D., P.C. 3532 Brodhead Road Monaca PA 15061 General <strong>Provider</strong> Beaver<br />

Adams William 001075 Katsur <strong>Dental</strong> & Orthodontics 7A Wal-Mart Plaza, Rte.18 Monaca PA 15061 General <strong>Provider</strong> Beaver<br />

Affolter John 001075 Katsur <strong>Dental</strong> & Orthodontics 7A Wal-Mart Plaza, Rte.18 Monaca PA 15061 General <strong>Provider</strong> Beaver<br />

Alagirisamy Kiruthika 001075 Katsur <strong>Dental</strong> & Orthodontics 7A Wal-Mart Plaza, Rte.18 Monaca PA 15061 General <strong>Provider</strong> Beaver<br />

Carozza Roselyn 001075 Katsur <strong>Dental</strong> & Orthodontics 7A Wal-Mart Plaza, Rte.18 Monaca PA 15061 General <strong>Provider</strong> Beaver<br />

Cohen Ira 001075 Katsur <strong>Dental</strong> & Orthodontics 7A Wal-Mart Plaza, Rte.18 Monaca PA 15061 General <strong>Provider</strong> Beaver<br />

Dahar Nicholas 001075 Katsur <strong>Dental</strong> & Orthodontics 7A Wal-Mart Plaza, Rte.18 Monaca PA 15061 Orthodontist Beaver<br />

Damich Louis 001075 Katsur <strong>Dental</strong> & Orthodontics 7A Wal-Mart Plaza, Rte.18 Monaca PA 15061 General <strong>Provider</strong> Beaver<br />

Ghaffari Catherine 001075 Katsur <strong>Dental</strong> & Orthodontics 7A Wal-Mart Plaza, Rte.18 Monaca PA 15061 General <strong>Provider</strong> Beaver<br />

Ghajarnia M. Reza 001075 Katsur <strong>Dental</strong> & Orthodontics 7A Wal-Mart Plaza, Rte.18 Monaca PA 15061 Orthodontist Beaver<br />

Gillen Steve 001075 Katsur <strong>Dental</strong> & Orthodontics 7A Wal-Mart Plaza, Rte.18 Monaca PA 15061 General <strong>Provider</strong> Beaver<br />

Iszkula Steven 001075 Katsur <strong>Dental</strong> & Orthodontics 7A Wal-Mart Plaza, Rte.18 Monaca PA 15061 Orthodontist Beaver<br />

Katsur James 001075 Katsur <strong>Dental</strong> & Orthodontics 7A Wal-Mart Plaza, Rte.18 Monaca PA 15061 General <strong>Provider</strong> Beaver<br />

Khurana Leena 001075 Katsur <strong>Dental</strong> & Orthodontics 7A Wal-Mart Plaza, Rte.18 Monaca PA 15061 General <strong>Provider</strong> Beaver<br />

Kier Calvin 001075 Katsur <strong>Dental</strong> & Orthodontics 7A Wal-Mart Plaza, Rte.18 Monaca PA 15061 General <strong>Provider</strong> Beaver<br />

King David 001075 Katsur <strong>Dental</strong> & Orthodontics 7A Wal-Mart Plaza, Rte.18 Monaca PA 15061 Orthodontist Beaver<br />

Kolla Siva 001075 Katsur <strong>Dental</strong> & Orthodontics 7A Wal-Mart Plaza, Rte.18 Monaca PA 15061 General <strong>Provider</strong> Beaver<br />

Lewis Howell 001075 Katsur <strong>Dental</strong> & Orthodontics 7A Wal-Mart Plaza, Rte.18 Monaca PA 15061 Orthodontist Beaver<br />

Miller Van 001075 Katsur <strong>Dental</strong> & Orthodontics 7A Wal-Mart Plaza, Rte.18 Monaca PA 15061 Orthodontist Beaver<br />

Pryor Leroy 001075 Katsur <strong>Dental</strong> & Orthodontics 7A Wal-Mart Plaza, Rte.18 Monaca PA 15061 General <strong>Provider</strong> Beaver<br />

Rinchuse Dara 001075 Katsur <strong>Dental</strong> & Orthodontics 7A Wal-Mart Plaza, Rte.18 Monaca PA 15061 Orthodontist Beaver<br />

Schmidt Alan 001075 Katsur <strong>Dental</strong> & Orthodontics 7A Wal-Mart Plaza, Rte.18 Monaca PA 15061 General <strong>Provider</strong> Beaver<br />

Smiga Ingrid 001075 Katsur <strong>Dental</strong> & Orthodontics 7A Wal-Mart Plaza, Rte.18 Monaca PA 15061 General <strong>Provider</strong> Beaver<br />

Stein Mark 001075 Katsur <strong>Dental</strong> & Orthodontics 7A Wal-Mart Plaza, Rte.18 Monaca PA 15061 General <strong>Provider</strong> Beaver<br />

Tinnemeyer Anjuli 001075 Katsur <strong>Dental</strong> & Orthodontics 7A Wal-Mart Plaza, Rte.18 Monaca PA 15061 General <strong>Provider</strong> Beaver<br />

Zalakar Frank 001075 Katsur <strong>Dental</strong> & Orthodontics 7A Wal-Mart Plaza, Rte.18 Monaca PA 15061 General <strong>Provider</strong> Beaver<br />

Dandashi Moutaz 050691 Katsur <strong>Dental</strong> & Orthodontics Specialists 7A Wal-Mart Plaza, Route 18 Monaca PA 15061 Pedodontist Beaver<br />

Hertzler L Gregory 050691 Katsur <strong>Dental</strong> & Orthodontics Specialists 7A Wal-Mart Plaza, Route 18 Monaca PA 15061 Oral Surgeon Beaver<br />

Kelly Derek 050691 Katsur <strong>Dental</strong> & Orthodontics Specialists 7A Wal-Mart Plaza, Route 18 Monaca PA 15061 Oral Surgeon Beaver<br />

Kier Gregory 050691 Katsur <strong>Dental</strong> & Orthodontics Specialists 7A Wal-Mart Plaza, Route 18 Monaca PA 15061 Periodontist Beaver<br />

Monti Richard 050691 Katsur <strong>Dental</strong> & Orthodontics Specialists 7A Wal-Mart Plaza, Route 18 Monaca PA 15061 Oral Surgeon Beaver<br />

Panossian Antoine 070971 A+ Oral Surgery Specialty Care PC 2230 North 5th St Hwy Reading PA 19605 Oral Surgeon Berks<br />

Tran David 070971 A+ Oral Surgery Specialty Care PC 2230 North 5th St Hwy Reading PA 19605 Oral Surgeon Berks<br />

Charkas Ahmad 070960 Allied Orthodontics PC 2230 N 5th St Hwy Reading PA 19605 Orthodontist Berks<br />

Evans Marianna 070960 Allied Orthodontics PC 2230 N 5th St Hwy Reading PA 19605 Orthodontist Berks<br />

Babameto Blendi 002360 Aspen <strong>Dental</strong> Associates of NY., P.C. 2733 Papermill Road Reading PA 19610 Oral Surgeon Berks<br />

Brier Ashley 002360 Aspen <strong>Dental</strong> Associates of NY., P.C. 2733 Papermill Road Reading PA 19610 General <strong>Provider</strong> Berks<br />

Ciarallo Robert 002360 Aspen <strong>Dental</strong> Associates of NY., P.C. 2733 Papermill Road Reading PA 19610 Oral Surgeon Berks<br />

Fellin Michael 002360 Aspen <strong>Dental</strong> Associates of NY., P.C. 2733 Papermill Road Reading PA 19610 General <strong>Provider</strong> Berks<br />

Singh Tanvir 002360 Aspen <strong>Dental</strong> Associates of NY., P.C. 2733 Papermill Road Reading PA 19610 General <strong>Provider</strong> Berks<br />

Withanachchi Janatha 002360 Aspen <strong>Dental</strong> Associates of NY., P.C. 2733 Papermill Road Reading PA 19610 Endodontist Berks<br />

* Indicates dentist that is accepting current patients only.<br />

All <strong>Select</strong> <strong>Plan</strong> Dentists Page 17<br />

1 Same as a DHMO with fixed member copayments, no annual maximum dollar limits, no waiting periods, no deductibles, no pre-authorization paperwork or pre-treatment estimates and no<br />

claim forms or proof of loss (except in the case of out-of-area emergencies). Member must enroll with a General Dentist. Fac ID is used to indicate which facility a member chooses.


SELECT PLAN 1 DENTIST DIRECTORY<br />

Dentists listed are under contract as of 10/1/12<br />

Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />

Young Donovan 002360 Aspen <strong>Dental</strong> Associates of NY., P.C. 2733 Papermill Road Reading PA 19610 General <strong>Provider</strong> Berks<br />

Diak Steven 000973 <strong>Dental</strong> Health <strong>Services</strong> 1901 Ridgewood Rd. Wyomissing PA 19610 General <strong>Provider</strong> Berks<br />

Lee Young 000973 <strong>Dental</strong> Health <strong>Services</strong> 1901 Ridgewood Rd. Wyomissing PA 19610 General <strong>Provider</strong> Berks<br />

Check Jennifer 050334 Aspen <strong>Dental</strong> 3420 Pleasant Valley Blvd Altoona PA 16602 General <strong>Provider</strong> Blair<br />

Ciarallo Robert 050334 Aspen <strong>Dental</strong> 3420 Pleasant Valley Blvd Altoona PA 16602 Oral Surgeon Blair<br />

Cignetti Scott 050334 Aspen <strong>Dental</strong> 3420 Pleasant Valley Blvd Altoona PA 16602 General <strong>Provider</strong> Blair<br />

Fazio John 050334 Aspen <strong>Dental</strong> 3420 Pleasant Valley Blvd Altoona PA 16602 General <strong>Provider</strong> Blair<br />

Ferguson III William 050334 Aspen <strong>Dental</strong> 3420 Pleasant Valley Blvd Altoona PA 16602 General <strong>Provider</strong> Blair<br />

Grinberg Anna 050334 Aspen <strong>Dental</strong> 3420 Pleasant Valley Blvd Altoona PA 16602 General <strong>Provider</strong> Blair<br />

Malone Matthew 050334 Aspen <strong>Dental</strong> 3420 Pleasant Valley Blvd Altoona PA 16602 General <strong>Provider</strong> Blair<br />

McCann Eve 050334 Aspen <strong>Dental</strong> 3420 Pleasant Valley Blvd Altoona PA 16602 General <strong>Provider</strong> Blair<br />

McClain Kelly 050334 Aspen <strong>Dental</strong> 3420 Pleasant Valley Blvd Altoona PA 16602 General <strong>Provider</strong> Blair<br />

Monios George 050334 Aspen <strong>Dental</strong> 3420 Pleasant Valley Blvd Altoona PA 16602 General <strong>Provider</strong> Blair<br />

Raja Nabila 050334 Aspen <strong>Dental</strong> 3420 Pleasant Valley Blvd Altoona PA 16602 General <strong>Provider</strong> Blair<br />

Somers Mitchell 050334 Aspen <strong>Dental</strong> 3420 Pleasant Valley Blvd Altoona PA 16602 General <strong>Provider</strong> Blair<br />

Tam Dominic 050334 Aspen <strong>Dental</strong> 3420 Pleasant Valley Blvd Altoona PA 16602 General <strong>Provider</strong> Blair<br />

Tran David 095226 A + Oral Surgery Specialty Care PC 1950 Street Rd, Ste 200 Bensalem PA 19020 Oral Surgeon Bucks<br />

Agrawal Avanti 002349 A 1 Family <strong>Dental</strong> Care PC 1950 Street Road, Suite 200 Bensalem PA 19020 General <strong>Provider</strong> Bucks<br />

Ahmadzadeh Bijan 002349 A 1 Family <strong>Dental</strong> Care PC 1950 Street Road, Suite 200 Bensalem PA 19020 General <strong>Provider</strong> Bucks<br />

Chakraborty Rajashree 002349 A 1 Family <strong>Dental</strong> Care PC 1950 Street Road, Suite 200 Bensalem PA 19020 General <strong>Provider</strong> Bucks<br />

Dapkute Ingrida 002349 A 1 Family <strong>Dental</strong> Care PC 1950 Street Road, Suite 200 Bensalem PA 19020 General <strong>Provider</strong> Bucks<br />

Derosa Daniel 002349 A 1 Family <strong>Dental</strong> Care PC 1950 Street Road, Suite 200 Bensalem PA 19020 General <strong>Provider</strong> Bucks<br />

Desai Kaushal 002349 A 1 Family <strong>Dental</strong> Care PC 1950 Street Road, Suite 200 Bensalem PA 19020 General <strong>Provider</strong> Bucks<br />

Gombar Anna 002349 A 1 Family <strong>Dental</strong> Care PC 1950 Street Road, Suite 200 Bensalem PA 19020 General <strong>Provider</strong> Bucks<br />

Gundabathula Sindhu 002349 A 1 Family <strong>Dental</strong> Care PC 1950 Street Road, Suite 200 Bensalem PA 19020 General <strong>Provider</strong> Bucks<br />

Kopp Anatoliy 002349 A 1 Family <strong>Dental</strong> Care PC 1950 Street Road, Suite 200 Bensalem PA 19020 General <strong>Provider</strong> Bucks<br />

Merin Jared 002349 A 1 Family <strong>Dental</strong> Care PC 1950 Street Road, Suite 200 Bensalem PA 19020 General <strong>Provider</strong> Bucks<br />

Miller Andrew 002349 A 1 Family <strong>Dental</strong> Care PC 1950 Street Road, Suite 200 Bensalem PA 19020 General <strong>Provider</strong> Bucks<br />

Mitelman Alexandra 002349 A 1 Family <strong>Dental</strong> Care PC 1950 Street Road, Suite 200 Bensalem PA 19020 General <strong>Provider</strong> Bucks<br />

Moriarty Sean 002349 A 1 Family <strong>Dental</strong> Care PC 1950 Street Road, Suite 200 Bensalem PA 19020 General <strong>Provider</strong> Bucks<br />

Nayeem Arbina 002349 A 1 Family <strong>Dental</strong> Care PC 1950 Street Road, Suite 200 Bensalem PA 19020 General <strong>Provider</strong> Bucks<br />

Patel Ashish 002349 A 1 Family <strong>Dental</strong> Care PC 1950 Street Road, Suite 200 Bensalem PA 19020 General <strong>Provider</strong> Bucks<br />

Savani Bhaskar 002349 A 1 Family <strong>Dental</strong> Care PC 1950 Street Road, Suite 200 Bensalem PA 19020 General <strong>Provider</strong> Bucks<br />

Savani Bhumi 002349 A 1 Family <strong>Dental</strong> Care PC 1950 Street Road, Suite 200 Bensalem PA 19020 General <strong>Provider</strong> Bucks<br />

Savani Niranjan 002349 A 1 Family <strong>Dental</strong> Care PC 1950 Street Road, Suite 200 Bensalem PA 19020 General <strong>Provider</strong> Bucks<br />

Todd Meredith 002349 A 1 Family <strong>Dental</strong> Care PC 1950 Street Road, Suite 200 Bensalem PA 19020 General <strong>Provider</strong> Bucks<br />

Vinogradov Yelena 002349 A 1 Family <strong>Dental</strong> Care PC 1950 Street Road, Suite 200 Bensalem PA 19020 General <strong>Provider</strong> Bucks<br />

Vincze Bela 080815 Dentistry 4 Kids 2075 Byberry Rd, Suite 101 Bensalem PA 19020 Pedodontist Bucks<br />

Hodges Kellyn 050524 Dr Kellyn Hodges DMD 2212 Street Rd Bensalem PA 19020 Orthodontist Bucks<br />

Sakkal Sameh 002781 Mohamed Sakkal, D.M.D. 1541 Brookwood Drive Bensalem PA 19020 General <strong>Provider</strong> Bucks<br />

Patel Mukund 001203 Mukund K. Patel, D.D.S., P.C. 2776 Knights Rd. Bensalem PA 19020 General <strong>Provider</strong> Bucks<br />

Kahlon Sonia 050565 Rich Family Orthodontics 3554 Hulmeville Rd, Suite 110 Bensalem PA 19020 Orthodontist Bucks<br />

Rich Jeremy 050565 Rich Family Orthodontics 3554 Hulmeville Rd, Suite 110 Bensalem PA 19020 Orthodontist Bucks<br />

Agrawal Avanti 002352 A+ Family <strong>Dental</strong> Care PC 1500 Horizon Drive, Suite 104 Chalfont PA 18914 General <strong>Provider</strong> Bucks<br />

Ahmadzadeh Bijan 002352 A+ Family <strong>Dental</strong> Care PC 1500 Horizon Drive, Suite 104 Chalfont PA 18914 General <strong>Provider</strong> Bucks<br />

Dapkute Ingrida 002352 A+ Family <strong>Dental</strong> Care PC 1500 Horizon Drive, Suite 104 Chalfont PA 18914 General <strong>Provider</strong> Bucks<br />

Derosa Daniel 002352 A+ Family <strong>Dental</strong> Care PC 1500 Horizon Drive, Suite 104 Chalfont PA 18914 General <strong>Provider</strong> Bucks<br />

Desai Kaushal 002352 A+ Family <strong>Dental</strong> Care PC 1500 Horizon Drive, Suite 104 Chalfont PA 18914 General <strong>Provider</strong> Bucks<br />

Gombar Anna 002352 A+ Family <strong>Dental</strong> Care PC 1500 Horizon Drive, Suite 104 Chalfont PA 18914 General <strong>Provider</strong> Bucks<br />

Kandov Olga 002352 A+ Family <strong>Dental</strong> Care PC 1500 Horizon Drive, Suite 104 Chalfont PA 18914 General <strong>Provider</strong> Bucks<br />

Kopp Anatoliy 002352 A+ Family <strong>Dental</strong> Care PC 1500 Horizon Drive, Suite 104 Chalfont PA 18914 General <strong>Provider</strong> Bucks<br />

Merin Jared 002352 A+ Family <strong>Dental</strong> Care PC 1500 Horizon Drive, Suite 104 Chalfont PA 18914 General <strong>Provider</strong> Bucks<br />

Mitelman Alexandra 002352 A+ Family <strong>Dental</strong> Care PC 1500 Horizon Drive, Suite 104 Chalfont PA 18914 General <strong>Provider</strong> Bucks<br />

Moriarty Sean 002352 A+ Family <strong>Dental</strong> Care PC 1500 Horizon Drive, Suite 104 Chalfont PA 18914 General <strong>Provider</strong> Bucks<br />

Savani Bhaskar 002352 A+ Family <strong>Dental</strong> Care PC 1500 Horizon Drive, Suite 104 Chalfont PA 18914 General <strong>Provider</strong> Bucks<br />

Savani Bhumi 002352 A+ Family <strong>Dental</strong> Care PC 1500 Horizon Drive, Suite 104 Chalfont PA 18914 General <strong>Provider</strong> Bucks<br />

Savani Niranjan 002352 A+ Family <strong>Dental</strong> Care PC 1500 Horizon Drive, Suite 104 Chalfont PA 18914 General <strong>Provider</strong> Bucks<br />

Simeone Mark 002352 A+ Family <strong>Dental</strong> Care PC 1500 Horizon Drive, Suite 104 Chalfont PA 18914 General <strong>Provider</strong> Bucks<br />

Todd Meredith 002352 A+ Family <strong>Dental</strong> Care PC 1500 Horizon Drive, Suite 104 Chalfont PA 18914 General <strong>Provider</strong> Bucks<br />

Bandelac Georges 070945 A+ Periodontic Specialty Care PC 1500 Horizon Dr, Suite 104 Chalfont PA 18914 Periodontist Bucks<br />

Evans Marianna 070945 A+ Periodontic Specialty Care PC 1500 Horizon Dr, Suite 104 Chalfont PA 18914 Periodontist Bucks<br />

Patel Prafulchandra 039700 American <strong>Dental</strong> Care LLC 817 North Easton Road Doylestown PA 18901 General <strong>Provider</strong> Bucks<br />

Rudolf Donald 000673 Donald Rudolf, D.D.S.,P.C. 103 Progress Drive Doylestown PA 18901 Oral Surgeon Bucks<br />

Charkas Ahmad 070961 Allied Orthodontics PC 4259 W Swamp Rd, Suite 104 Doylestown PA 18902 Orthodontist Bucks<br />

Evans Marianna 070961 Allied Orthodontics PC 4259 W Swamp Rd, Suite 104 Doylestown PA 18902 Orthodontist Bucks<br />

Agrawal Avanti 070931 Ardent Smile 4259 W Swamp Rd Doylestown PA 18902 General <strong>Provider</strong> Bucks<br />

* Indicates dentist that is accepting current patients only.<br />

All <strong>Select</strong> <strong>Plan</strong> Dentists Page 18<br />

1 Same as a DHMO with fixed member copayments, no annual maximum dollar limits, no waiting periods, no deductibles, no pre-authorization paperwork or pre-treatment estimates and no<br />

claim forms or proof of loss (except in the case of out-of-area emergencies). Member must enroll with a General Dentist. Fac ID is used to indicate which facility a member chooses.


SELECT PLAN 1 DENTIST DIRECTORY<br />

Dentists listed are under contract as of 10/1/12<br />

Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />

Derosa Daniel 070931 Ardent Smile 4259 W Swamp Rd Doylestown PA 18902 General <strong>Provider</strong> Bucks<br />

Gombar Anna 070931 Ardent Smile 4259 W Swamp Rd Doylestown PA 18902 General <strong>Provider</strong> Bucks<br />

Kopp Anatoliy 070931 Ardent Smile 4259 W Swamp Rd Doylestown PA 18902 General <strong>Provider</strong> Bucks<br />

Savani Bhumi 070931 Ardent Smile 4259 W Swamp Rd Doylestown PA 18902 General <strong>Provider</strong> Bucks<br />

Thoma Fjoralba 070931 Ardent Smile 4259 W Swamp Rd Doylestown PA 18902 General <strong>Provider</strong> Bucks<br />

Todd Meredith 070931 Ardent Smile 4259 W Swamp Rd Doylestown PA 18902 General <strong>Provider</strong> Bucks<br />

Vinnikov Inna 070931 Ardent Smile 4259 W Swamp Rd Doylestown PA 18902 General <strong>Provider</strong> Bucks<br />

Patel Nalin 000387 Fairless Hills <strong>Dental</strong> Group 532 S. Oxford Valley Rd. Fairless Hills PA 19030 General <strong>Provider</strong> Bucks<br />

Barot Ashok 079782 PA <strong>Dental</strong> Group 320 N Oxford Valley Rd Fairless Hills PA 19030 General <strong>Provider</strong> Bucks<br />

He Yuling 079782 PA <strong>Dental</strong> Group 320 N Oxford Valley Rd Fairless Hills PA 19030 General <strong>Provider</strong> Bucks<br />

Jeong Jihyon 079782 PA <strong>Dental</strong> Group 320 N Oxford Valley Rd Fairless Hills PA 19030 General <strong>Provider</strong> Bucks<br />

Patmidi Avanti 079782 PA <strong>Dental</strong> Group 320 N Oxford Valley Rd Fairless Hills PA 19030 General <strong>Provider</strong> Bucks<br />

Reddy Hima 079782 PA <strong>Dental</strong> Group 320 N Oxford Valley Rd Fairless Hills PA 19030 General <strong>Provider</strong> Bucks<br />

Rotwein Benjamin 079782 PA <strong>Dental</strong> Group 320 N Oxford Valley Rd Fairless Hills PA 19030 General <strong>Provider</strong> Bucks<br />

Tadisena Archana 079782 PA <strong>Dental</strong> Group 320 N Oxford Valley Rd Fairless Hills PA 19030 General <strong>Provider</strong> Bucks<br />

Anagnostakos Paul 002839 Feasterville Family Dentistry 4 Arbor Lane Feasterville Trevose PA 19053 General <strong>Provider</strong> Bucks<br />

Goldin Sofia 001908 Sofia Goldin, D.M.D. 227 Bustleton Pike Feasterville Trevose PA 19053 General <strong>Provider</strong> Bucks<br />

Tran David 084470 A + Oral Surgery Specialty Care PC 404 Middletown Blvd, Ste 300 Langhorne PA 19047 Oral Surgeon Bucks<br />

Agrawal Avanti 002350 A 1 Family <strong>Dental</strong> Care PC 404 Middletown Boulevard,, Suite 300 Langhorne PA 19047 General <strong>Provider</strong> Bucks<br />

Ahmadzadeh Bijan 002350 A 1 Family <strong>Dental</strong> Care PC 404 Middletown Boulevard,, Suite 300 Langhorne PA 19047 General <strong>Provider</strong> Bucks<br />

Cheema Tandeep 002350 A 1 Family <strong>Dental</strong> Care PC 404 Middletown Boulevard,, Suite 300 Langhorne PA 19047 General <strong>Provider</strong> Bucks<br />

Dapkute Ingrida 002350 A 1 Family <strong>Dental</strong> Care PC 404 Middletown Boulevard,, Suite 300 Langhorne PA 19047 General <strong>Provider</strong> Bucks<br />

Derosa Daniel 002350 A 1 Family <strong>Dental</strong> Care PC 404 Middletown Boulevard,, Suite 300 Langhorne PA 19047 General <strong>Provider</strong> Bucks<br />

Desai Kaushal 002350 A 1 Family <strong>Dental</strong> Care PC 404 Middletown Boulevard,, Suite 300 Langhorne PA 19047 General <strong>Provider</strong> Bucks<br />

Gombar Anna 002350 A 1 Family <strong>Dental</strong> Care PC 404 Middletown Boulevard,, Suite 300 Langhorne PA 19047 General <strong>Provider</strong> Bucks<br />

Haribabu Vasanthi 002350 A 1 Family <strong>Dental</strong> Care PC 404 Middletown Boulevard,, Suite 300 Langhorne PA 19047 General <strong>Provider</strong> Bucks<br />

Katikaneni Ramkumar 002350 A 1 Family <strong>Dental</strong> Care PC 404 Middletown Boulevard,, Suite 300 Langhorne PA 19047 General <strong>Provider</strong> Bucks<br />

Kopp Anatoliy 002350 A 1 Family <strong>Dental</strong> Care PC 404 Middletown Boulevard,, Suite 300 Langhorne PA 19047 General <strong>Provider</strong> Bucks<br />

Merin Jared 002350 A 1 Family <strong>Dental</strong> Care PC 404 Middletown Boulevard,, Suite 300 Langhorne PA 19047 General <strong>Provider</strong> Bucks<br />

Mitelman Alexandra 002350 A 1 Family <strong>Dental</strong> Care PC 404 Middletown Boulevard,, Suite 300 Langhorne PA 19047 General <strong>Provider</strong> Bucks<br />

Moriarty Sean 002350 A 1 Family <strong>Dental</strong> Care PC 404 Middletown Boulevard,, Suite 300 Langhorne PA 19047 General <strong>Provider</strong> Bucks<br />

Nanda Ranveet 002350 A 1 Family <strong>Dental</strong> Care PC 404 Middletown Boulevard,, Suite 300 Langhorne PA 19047 General <strong>Provider</strong> Bucks<br />

Pahng Christine 002350 A 1 Family <strong>Dental</strong> Care PC 404 Middletown Boulevard,, Suite 300 Langhorne PA 19047 General <strong>Provider</strong> Bucks<br />

Savani Bhaskar 002350 A 1 Family <strong>Dental</strong> Care PC 404 Middletown Boulevard,, Suite 300 Langhorne PA 19047 General <strong>Provider</strong> Bucks<br />

Savani Bhumi 002350 A 1 Family <strong>Dental</strong> Care PC 404 Middletown Boulevard,, Suite 300 Langhorne PA 19047 General <strong>Provider</strong> Bucks<br />

Savani Niranjan 002350 A 1 Family <strong>Dental</strong> Care PC 404 Middletown Boulevard,, Suite 300 Langhorne PA 19047 General <strong>Provider</strong> Bucks<br />

Todd Meredith 002350 A 1 Family <strong>Dental</strong> Care PC 404 Middletown Boulevard,, Suite 300 Langhorne PA 19047 General <strong>Provider</strong> Bucks<br />

Charkas Ahmad 070953 Allied Orthodontics PC 402 Middletown Blvd, Suite 200 Langhorne PA 19047 Orthodontist Bucks<br />

Evans Marianna 070953 Allied Orthodontics PC 402 Middletown Blvd, Suite 200 Langhorne PA 19047 Orthodontist Bucks<br />

Kahlon Sonia 051064 Rich Family Orthodontics 370 Middletown Blvd, 509 Langhorne PA 19047 Orthodontist Bucks<br />

Rich Jeremy 051064 Rich Family Orthodontics 370 Middletown Blvd, 509 Langhorne PA 19047 Orthodontist Bucks<br />

Lehrhaupt Solomon 081561 AllRight <strong>Dental</strong>, PC 229 Plaza Blvd Morrisville PA 19067 General <strong>Provider</strong> Bucks<br />

Sambaraju Haritha 081561 AllRight <strong>Dental</strong>, PC 229 Plaza Blvd Morrisville PA 19067 General <strong>Provider</strong> Bucks<br />

Vora Vasant 000837 Vasant K. Vora, D.D.S. 301 Oxford Valley Rd., Suite 203A Morrisville PA 19067 General <strong>Provider</strong> Bucks<br />

Nadimpalli Sujatha 061336 New Britain <strong>Dental</strong> Center 108 A W Butler Ave New Britain PA 18901 General <strong>Provider</strong> Bucks<br />

Yates M. Alan 000675 M. Alan Yates, D.M.D. 638 Newton-Yardley Rd., Suite 2A Newtown PA 18940 Oral Surgeon Bucks<br />

Goldberger Harvey 000379 Smile Maker <strong>Dental</strong> 26 Eagle Rd. Newtown PA 18940 General <strong>Provider</strong> Bucks<br />

Tran David 096626 A + Oral Surgery Specialty Care PC 24 S 14th St Quakertown PA 18951 Oral Surgeon Bucks<br />

Agrawal Avanti 001023 A+ Family <strong>Dental</strong> Care PC 24 South 14th Street Quakertown PA 18951 General <strong>Provider</strong> Bucks<br />

Ahmadzadeh Bijan 001023 A+ Family <strong>Dental</strong> Care PC 24 South 14th Street Quakertown PA 18951 General <strong>Provider</strong> Bucks<br />

Bindra Atalinder 001023 A+ Family <strong>Dental</strong> Care PC 24 South 14th Street Quakertown PA 18951 General <strong>Provider</strong> Bucks<br />

Chong Woojae 001023 A+ Family <strong>Dental</strong> Care PC 24 South 14th Street Quakertown PA 18951 Periodontist Bucks<br />

Dapkute Ingrida 001023 A+ Family <strong>Dental</strong> Care PC 24 South 14th Street Quakertown PA 18951 General <strong>Provider</strong> Bucks<br />

Derosa Daniel 001023 A+ Family <strong>Dental</strong> Care PC 24 South 14th Street Quakertown PA 18951 General <strong>Provider</strong> Bucks<br />

Desai Kaushal 001023 A+ Family <strong>Dental</strong> Care PC 24 South 14th Street Quakertown PA 18951 General <strong>Provider</strong> Bucks<br />

Gherca Mirabela 001023 A+ Family <strong>Dental</strong> Care PC 24 South 14th Street Quakertown PA 18951 General <strong>Provider</strong> Bucks<br />

Gombar Anna 001023 A+ Family <strong>Dental</strong> Care PC 24 South 14th Street Quakertown PA 18951 General <strong>Provider</strong> Bucks<br />

Hong Seong 001023 A+ Family <strong>Dental</strong> Care PC 24 South 14th Street Quakertown PA 18951 General <strong>Provider</strong> Bucks<br />

Kopp Anatoliy 001023 A+ Family <strong>Dental</strong> Care PC 24 South 14th Street Quakertown PA 18951 General <strong>Provider</strong> Bucks<br />

Liang Yuling 001023 A+ Family <strong>Dental</strong> Care PC 24 South 14th Street Quakertown PA 18951 General <strong>Provider</strong> Bucks<br />

Merin Jared 001023 A+ Family <strong>Dental</strong> Care PC 24 South 14th Street Quakertown PA 18951 General <strong>Provider</strong> Bucks<br />

Mitelman Alexandra 001023 A+ Family <strong>Dental</strong> Care PC 24 South 14th Street Quakertown PA 18951 General <strong>Provider</strong> Bucks<br />

Moriarty Sean 001023 A+ Family <strong>Dental</strong> Care PC 24 South 14th Street Quakertown PA 18951 General <strong>Provider</strong> Bucks<br />

Patoliya Keyur 001023 A+ Family <strong>Dental</strong> Care PC 24 South 14th Street Quakertown PA 18951 General <strong>Provider</strong> Bucks<br />

Savani Bhaskar 001023 A+ Family <strong>Dental</strong> Care PC 24 South 14th Street Quakertown PA 18951 General <strong>Provider</strong> Bucks<br />

Savani Bhumi 001023 A+ Family <strong>Dental</strong> Care PC 24 South 14th Street Quakertown PA 18951 General <strong>Provider</strong> Bucks<br />

* Indicates dentist that is accepting current patients only.<br />

All <strong>Select</strong> <strong>Plan</strong> Dentists Page 19<br />

1 Same as a DHMO with fixed member copayments, no annual maximum dollar limits, no waiting periods, no deductibles, no pre-authorization paperwork or pre-treatment estimates and no<br />

claim forms or proof of loss (except in the case of out-of-area emergencies). Member must enroll with a General Dentist. Fac ID is used to indicate which facility a member chooses.


SELECT PLAN 1 DENTIST DIRECTORY<br />

Dentists listed are under contract as of 10/1/12<br />

Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />

Savani Niranjan 001023 A+ Family <strong>Dental</strong> Care PC 24 South 14th Street Quakertown PA 18951 General <strong>Provider</strong> Bucks<br />

Tantucco Kathleen 001023 A+ Family <strong>Dental</strong> Care PC 24 South 14th Street Quakertown PA 18951 General <strong>Provider</strong> Bucks<br />

Todd Meredith 001023 A+ Family <strong>Dental</strong> Care PC 24 South 14th Street Quakertown PA 18951 General <strong>Provider</strong> Bucks<br />

Bandelac Georges 070944 A+ Periodontic Specialty Care PC 24 S 14th St Quakertown PA 18951 Periodontist Bucks<br />

Evans Marianna 070944 A+ Periodontic Specialty Care PC 24 S 14th St Quakertown PA 18951 Periodontist Bucks<br />

Charkas Ahmad 070952 Allied Orthodontics PC 24 S 14th St Quakertown PA 18951 Orthodontist Bucks<br />

Evans Marianna 070952 Allied Orthodontics PC 24 S 14th St Quakertown PA 18951 Orthodontist Bucks<br />

Bhatnagar Payal 078266 Aspen <strong>Dental</strong> 90 North West End Blvd Quakertown PA 18951 General <strong>Provider</strong> Bucks<br />

Chadha Chandan 078266 Aspen <strong>Dental</strong> 90 North West End Blvd Quakertown PA 18951 General <strong>Provider</strong> Bucks<br />

Kim Peter 078266 Aspen <strong>Dental</strong> 90 North West End Blvd Quakertown PA 18951 General <strong>Provider</strong> Bucks<br />

Malhotra Swati 078266 Aspen <strong>Dental</strong> 90 North West End Blvd Quakertown PA 18951 General <strong>Provider</strong> Bucks<br />

Obaid Michel 078266 Aspen <strong>Dental</strong> 90 North West End Blvd Quakertown PA 18951 General <strong>Provider</strong> Bucks<br />

Sambaraju Haritha 078266 Aspen <strong>Dental</strong> 90 North West End Blvd Quakertown PA 18951 General <strong>Provider</strong> Bucks<br />

Withanachchi Janatha 078266 Aspen <strong>Dental</strong> 90 North West End Blvd Quakertown PA 18951 Endodontist Bucks<br />

Yi Tyler 078266 Aspen <strong>Dental</strong> 90 North West End Blvd Quakertown PA 18951 General <strong>Provider</strong> Bucks<br />

Sayles Erik 000666 Drs. Schwartz & Schelkun Associates Brownstone Office Complex, 853 2nd St. Pke, Ste.A- Richboro PA 18954 Oral Surgeon Bucks<br />

Schelkun Paul 000666 Drs. Schwartz & Schelkun Associates Brownstone Office Complex, 853 2nd St. Pke, Ste.A- Richboro PA 18954 Oral Surgeon Bucks<br />

Metz August 069529 Apex Smiles LLC 771 2nd St Pike Southampton PA 18966 General <strong>Provider</strong> Bucks<br />

Cichetti Michael 070996 Cichetti & DelliGatti Orthodontics PC 928 Jaymor Rd, Suite 130A Southampton PA 18966 Orthodontist Bucks<br />

DelliGatti Steve 070996 Cichetti & DelliGatti Orthodontics PC 928 Jaymor Rd, Suite 130A Southampton PA 18966 Orthodontist Bucks<br />

Milewski Michael 070996 Cichetti & DelliGatti Orthodontics PC 928 Jaymor Rd, Suite 130A Southampton PA 18966 Orthodontist Bucks<br />

Orozco Jacob 070996 Cichetti & DelliGatti Orthodontics PC 928 Jaymor Rd, Suite 130A Southampton PA 18966 Orthodontist Bucks<br />

Bahn Paul 070987 Pediatric <strong>Dental</strong> Associates 928 Jaymor Rd, Suite 130 A Southampton PA 18966 Pedodontist Bucks<br />

D'Agostino Alegra 070987 Pediatric <strong>Dental</strong> Associates 928 Jaymor Rd, Suite 130 A Southampton PA 18966 Pedodontist Bucks<br />

Hamilton Sharon 070987 Pediatric <strong>Dental</strong> Associates 928 Jaymor Rd, Suite 130 A Southampton PA 18966 Pedodontist Bucks<br />

Kay Lewis 070987 Pediatric <strong>Dental</strong> Associates 928 Jaymor Rd, Suite 130 A Southampton PA 18966 Pedodontist Bucks<br />

Quinn Noah 070987 Pediatric <strong>Dental</strong> Associates 928 Jaymor Rd, Suite 130 A Southampton PA 18966 Pedodontist Bucks<br />

Rosenbaum Michael 070987 Pediatric <strong>Dental</strong> Associates 928 Jaymor Rd, Suite 130 A Southampton PA 18966 Pedodontist Bucks<br />

Thomas Kimberly 070987 Pediatric <strong>Dental</strong> Associates 928 Jaymor Rd, Suite 130 A Southampton PA 18966 Pedodontist Bucks<br />

Sayles Erik 000665 Drs. Schwartz & Schelkun Associates 158 York Road Warminster PA 18974 Oral Surgeon Bucks<br />

Schelkun Paul 000665 Drs. Schwartz & Schelkun Associates 158 York Road Warminster PA 18974 Oral Surgeon Bucks<br />

Lee Elliot 078283 Warrington <strong>Dental</strong> Arts 865 Easton Road, Suite 110 Warrington PA 18976 General <strong>Provider</strong> Bucks<br />

Yoo Joo 078283 Warrington <strong>Dental</strong> Arts 865 Easton Road, Suite 110 Warrington PA 18976 General <strong>Provider</strong> Bucks<br />

Motwani Amit 002576 Warrington <strong>Dental</strong> PC 1380 Easton Rd Warrington PA 18976 General <strong>Provider</strong> Bucks<br />

Dudhat Dilip 040338 Radiant Smiles at Floral Vale 117 Floral Vale Blvd Yardley PA 19067 General <strong>Provider</strong> Bucks<br />

Hazard Amelia 040338 Radiant Smiles at Floral Vale 117 Floral Vale Blvd Yardley PA 19067 General <strong>Provider</strong> Bucks<br />

Kalanuria Vinita 040338 Radiant Smiles at Floral Vale 117 Floral Vale Blvd Yardley PA 19067 General <strong>Provider</strong> Bucks<br />

Metz August 040338 Radiant Smiles at Floral Vale 117 Floral Vale Blvd Yardley PA 19067 General <strong>Provider</strong> Bucks<br />

Aviso Venice 038072 Smile Today <strong>Dental</strong> LLC 301 Oxford Valley Rd, Suite 1301 Yardley PA 19067 General <strong>Provider</strong> Bucks<br />

Phan Kathy 038072 Smile Today <strong>Dental</strong> LLC 301 Oxford Valley Rd, Suite 1301 Yardley PA 19067 General <strong>Provider</strong> Bucks<br />

Ciarallo Robert 037964 Aspen <strong>Dental</strong> of Butler 256 New Castle Rd Butler PA 16001 Oral Surgeon Butler<br />

Garver Eric 037964 Aspen <strong>Dental</strong> of Butler 256 New Castle Rd Butler PA 16001 General <strong>Provider</strong> Butler<br />

Grinberg Anna 037964 Aspen <strong>Dental</strong> of Butler 256 New Castle Rd Butler PA 16001 General <strong>Provider</strong> Butler<br />

Laughrey Nathan 037964 Aspen <strong>Dental</strong> of Butler 256 New Castle Rd Butler PA 16001 General <strong>Provider</strong> Butler<br />

Ruprecht Heather 037964 Aspen <strong>Dental</strong> of Butler 256 New Castle Rd Butler PA 16001 General <strong>Provider</strong> Butler<br />

Hiras John 001348 Butler <strong>Dental</strong> Associates 121 South Main Street Butler PA 16001 General <strong>Provider</strong> Butler<br />

Manalo Maria 001348 Butler <strong>Dental</strong> Associates 121 South Main Street Butler PA 16001 General <strong>Provider</strong> Butler<br />

Terasavage William 001348 Butler <strong>Dental</strong> Associates 121 South Main Street Butler PA 16001 General <strong>Provider</strong> Butler<br />

Conquest Matthew 002197 Snyder and Dugar Oral and Maxillofacial Surgery 373 Stirling Village Butler PA 16001 Oral Surgeon Butler<br />

Dugan Michael 002197 Snyder and Dugar Oral and Maxillofacial Surgery 373 Stirling Village Butler PA 16001 Oral Surgeon Butler<br />

Snyder Richard 002197 Snyder and Dugar Oral and Maxillofacial Surgery 373 Stirling Village Butler PA 16001 Oral Surgeon Butler<br />

Sweeney Patrick 002197 Snyder and Dugar Oral and Maxillofacial Surgery 373 Stirling Village Butler PA 16001 Oral Surgeon Butler<br />

Garver Eric 050865 Aspen <strong>Dental</strong> 20000 Route 19, Suite 300 Cranberry Township PA 16066 General <strong>Provider</strong> Butler<br />

Grinberg Anna 050865 Aspen <strong>Dental</strong> 20000 Route 19, Suite 300 Cranberry Township PA 16066 General <strong>Provider</strong> Butler<br />

Laughrey Nathan 050865 Aspen <strong>Dental</strong> 20000 Route 19, Suite 300 Cranberry Township PA 16066 General <strong>Provider</strong> Butler<br />

Ruprecht Heather 050865 Aspen <strong>Dental</strong> 20000 Route 19, Suite 300 Cranberry Township PA 16066 General <strong>Provider</strong> Butler<br />

Morrow Bartley 001450 Generational <strong>Dental</strong> Associates 2610 Rochester Road Cranberry Township PA 16066 General <strong>Provider</strong> Butler<br />

Kampas Ronald 079820 Kampas Orthodontics PC 7011 Crider Rd, Suite 104 Mars PA 16046 Orthodontist Butler<br />

Feduska Linda 061408 My Best Smile North 518 Myoma Rd, Suite 200 Mars PA 16046 General <strong>Provider</strong> Butler<br />

Kokai John 061408 My Best Smile North 518 Myoma Rd, Suite 200 Mars PA 16046 General <strong>Provider</strong> Butler<br />

Manalo Alfredo 001298 North Pointe <strong>Dental</strong> Associates 7031 Crider Road, Suite 200 Mars PA 16046 Oral Surgeon Butler<br />

Novotny Greg 037626 Allied <strong>Dental</strong> Group, Ltd. 234 S. Main St. Slippery Rock PA 16057 General <strong>Provider</strong> Butler<br />

Kampas Ronald 080783 Kampas Orthodontics PC 508 S Main St, Suite 103 Zelienople PA 16063 Orthodontist Butler<br />

Conquest Matthew 002198 Snyder and Dugar Oral and Maxillofacial Surgery 506 S. Main Street, Suite 2101 Zelienople PA 16063 Oral Surgeon Butler<br />

Dugan Michael 002198 Snyder and Dugar Oral and Maxillofacial Surgery 506 S. Main Street, Suite 2101 Zelienople PA 16063 Oral Surgeon Butler<br />

Snyder Richard 002198 Snyder and Dugar Oral and Maxillofacial Surgery 506 S. Main Street, Suite 2101 Zelienople PA 16063 Oral Surgeon Butler<br />

* Indicates dentist that is accepting current patients only.<br />

All <strong>Select</strong> <strong>Plan</strong> Dentists Page 20<br />

1 Same as a DHMO with fixed member copayments, no annual maximum dollar limits, no waiting periods, no deductibles, no pre-authorization paperwork or pre-treatment estimates and no<br />

claim forms or proof of loss (except in the case of out-of-area emergencies). Member must enroll with a General Dentist. Fac ID is used to indicate which facility a member chooses.


SELECT PLAN 1 DENTIST DIRECTORY<br />

Dentists listed are under contract as of 10/1/12<br />

Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />

Sweeney Patrick 002198 Snyder and Dugar Oral and Maxillofacial Surgery 506 S. Main Street, Suite 2101 Zelienople PA 16063 Oral Surgeon Butler<br />

Check Jennifer 002756 Aspen <strong>Dental</strong> 121 Town Center Dr. Johnstown PA 15904 General <strong>Provider</strong> Cambria<br />

Ciarallo Robert 002756 Aspen <strong>Dental</strong> 121 Town Center Dr. Johnstown PA 15904 Oral Surgeon Cambria<br />

Cignetti Scott 002756 Aspen <strong>Dental</strong> 121 Town Center Dr. Johnstown PA 15904 General <strong>Provider</strong> Cambria<br />

Fazio John 002756 Aspen <strong>Dental</strong> 121 Town Center Dr. Johnstown PA 15904 General <strong>Provider</strong> Cambria<br />

Ferguson III William 002756 Aspen <strong>Dental</strong> 121 Town Center Dr. Johnstown PA 15904 General <strong>Provider</strong> Cambria<br />

Grinberg Anna 002756 Aspen <strong>Dental</strong> 121 Town Center Dr. Johnstown PA 15904 General <strong>Provider</strong> Cambria<br />

Malone Matthew 002756 Aspen <strong>Dental</strong> 121 Town Center Dr. Johnstown PA 15904 General <strong>Provider</strong> Cambria<br />

McCann Eve 002756 Aspen <strong>Dental</strong> 121 Town Center Dr. Johnstown PA 15904 General <strong>Provider</strong> Cambria<br />

McClain Kelly 002756 Aspen <strong>Dental</strong> 121 Town Center Dr. Johnstown PA 15904 General <strong>Provider</strong> Cambria<br />

Monios George 002756 Aspen <strong>Dental</strong> 121 Town Center Dr. Johnstown PA 15904 General <strong>Provider</strong> Cambria<br />

Raja Nabila 002756 Aspen <strong>Dental</strong> 121 Town Center Dr. Johnstown PA 15904 General <strong>Provider</strong> Cambria<br />

Somers Mitchell 002756 Aspen <strong>Dental</strong> 121 Town Center Dr. Johnstown PA 15904 General <strong>Provider</strong> Cambria<br />

Tam Dominic 002756 Aspen <strong>Dental</strong> 121 Town Center Dr. Johnstown PA 15904 General <strong>Provider</strong> Cambria<br />

Burnheimer John 002393 John M. Burnheimer, D.M.D., P.C. 336 Bloomfield Street Johnstown PA 15904 Orthodontist Cambria<br />

Check Jennifer 038064 Aspen <strong>Dental</strong> 1715 N Atherton St State College PA 16803 General <strong>Provider</strong> Centre<br />

Ciarallo Robert 038064 Aspen <strong>Dental</strong> 1715 N Atherton St State College PA 16803 Oral Surgeon Centre<br />

Cignetti Scott 038064 Aspen <strong>Dental</strong> 1715 N Atherton St State College PA 16803 General <strong>Provider</strong> Centre<br />

Fazio John 038064 Aspen <strong>Dental</strong> 1715 N Atherton St State College PA 16803 General <strong>Provider</strong> Centre<br />

Ferguson III William 038064 Aspen <strong>Dental</strong> 1715 N Atherton St State College PA 16803 General <strong>Provider</strong> Centre<br />

Grinberg Anna 038064 Aspen <strong>Dental</strong> 1715 N Atherton St State College PA 16803 General <strong>Provider</strong> Centre<br />

Malone Matthew 038064 Aspen <strong>Dental</strong> 1715 N Atherton St State College PA 16803 General <strong>Provider</strong> Centre<br />

McCann Eve 038064 Aspen <strong>Dental</strong> 1715 N Atherton St State College PA 16803 General <strong>Provider</strong> Centre<br />

McClain Kelly 038064 Aspen <strong>Dental</strong> 1715 N Atherton St State College PA 16803 General <strong>Provider</strong> Centre<br />

Monios George 038064 Aspen <strong>Dental</strong> 1715 N Atherton St State College PA 16803 General <strong>Provider</strong> Centre<br />

Raja Nabila 038064 Aspen <strong>Dental</strong> 1715 N Atherton St State College PA 16803 General <strong>Provider</strong> Centre<br />

Somers Mitchell 038064 Aspen <strong>Dental</strong> 1715 N Atherton St State College PA 16803 General <strong>Provider</strong> Centre<br />

Tam Dominic 038064 Aspen <strong>Dental</strong> 1715 N Atherton St State College PA 16803 General <strong>Provider</strong> Centre<br />

Gretzula Chad 069563 Absolute Oral Surgery PC 616 E Lancaster Ave Berwyn PA 19312 Oral Surgeon Chester<br />

Tran David 085552 A + Oral Surgery Specialty Care PC 479 Thomas Jones Way, Ste 600 Exton PA 19341 Oral Surgeon Chester<br />

Bandelac Georges 070948 A+ Periodontic Specialty Care PC 479 Thomas Jones Way, Suite 600 Exton PA 19341 Periodontist Chester<br />

Evans Marianna 070948 A+ Periodontic Specialty Care PC 479 Thomas Jones Way, Suite 600 Exton PA 19341 Periodontist Chester<br />

Charkas Ahmad 070957 Allied Orthodontics PC 479 Thomas Jones Way, Suite 600 Exton PA 19341 Orthodontist Chester<br />

Evans Marianna 070957 Allied Orthodontics PC 479 Thomas Jones Way, Suite 600 Exton PA 19341 Orthodontist Chester<br />

Agrawal Avanti 050386 American Family <strong>Dental</strong> Care PC 479 Thomas Jones Way, Suite 600 Exton PA 19341 General <strong>Provider</strong> Chester<br />

Ahmadzadeh Bijan 050386 American Family <strong>Dental</strong> Care PC 479 Thomas Jones Way, Suite 600 Exton PA 19341 General <strong>Provider</strong> Chester<br />

Brown Benjamin 050386 American Family <strong>Dental</strong> Care PC 479 Thomas Jones Way, Suite 600 Exton PA 19341 General <strong>Provider</strong> Chester<br />

Dapkute Ingrida 050386 American Family <strong>Dental</strong> Care PC 479 Thomas Jones Way, Suite 600 Exton PA 19341 General <strong>Provider</strong> Chester<br />

Derosa Daniel 050386 American Family <strong>Dental</strong> Care PC 479 Thomas Jones Way, Suite 600 Exton PA 19341 General <strong>Provider</strong> Chester<br />

Desai Kaushal 050386 American Family <strong>Dental</strong> Care PC 479 Thomas Jones Way, Suite 600 Exton PA 19341 General <strong>Provider</strong> Chester<br />

Gombar Anna 050386 American Family <strong>Dental</strong> Care PC 479 Thomas Jones Way, Suite 600 Exton PA 19341 General <strong>Provider</strong> Chester<br />

Kim Sunghun 050386 American Family <strong>Dental</strong> Care PC 479 Thomas Jones Way, Suite 600 Exton PA 19341 General <strong>Provider</strong> Chester<br />

Kopp Anatoliy 050386 American Family <strong>Dental</strong> Care PC 479 Thomas Jones Way, Suite 600 Exton PA 19341 General <strong>Provider</strong> Chester<br />

Merin Jared 050386 American Family <strong>Dental</strong> Care PC 479 Thomas Jones Way, Suite 600 Exton PA 19341 General <strong>Provider</strong> Chester<br />

Mitelman Alexandra 050386 American Family <strong>Dental</strong> Care PC 479 Thomas Jones Way, Suite 600 Exton PA 19341 General <strong>Provider</strong> Chester<br />

Moriarty Sean 050386 American Family <strong>Dental</strong> Care PC 479 Thomas Jones Way, Suite 600 Exton PA 19341 General <strong>Provider</strong> Chester<br />

Nguyen Anna 050386 American Family <strong>Dental</strong> Care PC 479 Thomas Jones Way, Suite 600 Exton PA 19341 General <strong>Provider</strong> Chester<br />

Savani Bhaskar 050386 American Family <strong>Dental</strong> Care PC 479 Thomas Jones Way, Suite 600 Exton PA 19341 General <strong>Provider</strong> Chester<br />

Savani Bhumi 050386 American Family <strong>Dental</strong> Care PC 479 Thomas Jones Way, Suite 600 Exton PA 19341 General <strong>Provider</strong> Chester<br />

Savani Niranjan 050386 American Family <strong>Dental</strong> Care PC 479 Thomas Jones Way, Suite 600 Exton PA 19341 General <strong>Provider</strong> Chester<br />

Soliman John 050386 American Family <strong>Dental</strong> Care PC 479 Thomas Jones Way, Suite 600 Exton PA 19341 General <strong>Provider</strong> Chester<br />

Todd Meredith 050386 American Family <strong>Dental</strong> Care PC 479 Thomas Jones Way, Suite 600 Exton PA 19341 General <strong>Provider</strong> Chester<br />

Gorelik Tatyana 002317 Exton <strong>Dental</strong> Associates, LTD 436 Exton Commons Exton PA 19341 General <strong>Provider</strong> Chester<br />

Hook William 000848 William L. Hook, D.M.D., MSD 358 S. Balderston Drive Exton PA 19341 Orthodontist Chester<br />

* Yeung Alan 000510 Alan S Yeung, D.D.S. 250 W Lancaster Ave. #210 Paoli PA 19301 General <strong>Provider</strong> Chester<br />

Babameto Blendi 002742 Aspen <strong>Dental</strong> Associates of NY, PC 1100 Town Square Rd Pottstown PA 19465 Oral Surgeon Chester<br />

Brier Ashley 002742 Aspen <strong>Dental</strong> Associates of NY, PC 1100 Town Square Rd Pottstown PA 19465 General <strong>Provider</strong> Chester<br />

Ciarallo Robert 002742 Aspen <strong>Dental</strong> Associates of NY, PC 1100 Town Square Rd Pottstown PA 19465 Oral Surgeon Chester<br />

Fellin Michael 002742 Aspen <strong>Dental</strong> Associates of NY, PC 1100 Town Square Rd Pottstown PA 19465 General <strong>Provider</strong> Chester<br />

Singh Tanvir 002742 Aspen <strong>Dental</strong> Associates of NY, PC 1100 Town Square Rd Pottstown PA 19465 General <strong>Provider</strong> Chester<br />

Withanachchi Janatha 002742 Aspen <strong>Dental</strong> Associates of NY, PC 1100 Town Square Rd Pottstown PA 19465 Endodontist Chester<br />

Young Donovan 002742 Aspen <strong>Dental</strong> Associates of NY, PC 1100 Town Square Rd Pottstown PA 19465 General <strong>Provider</strong> Chester<br />

In Andrew 000628 Gentle <strong>Dental</strong> Thorndale LLC 3307 Lincoln Hwy Thorndale PA 19372 General <strong>Provider</strong> Chester<br />

Chen Thomas 037762 Jiten P. Gohel, DMD 913 E Boot Rd West Chester PA 19380 General <strong>Provider</strong> Chester<br />

Gohel Jiten 037762 Jiten P. Gohel, DMD 913 E Boot Rd West Chester PA 19380 General <strong>Provider</strong> Chester<br />

DeLoache Yvonne 001057 Yvonne DeLoache, D.D.S. 301 S. High Street West Chester PA 19382 General <strong>Provider</strong> Chester<br />

* Indicates dentist that is accepting current patients only.<br />

All <strong>Select</strong> <strong>Plan</strong> Dentists Page 21<br />

1 Same as a DHMO with fixed member copayments, no annual maximum dollar limits, no waiting periods, no deductibles, no pre-authorization paperwork or pre-treatment estimates and no<br />

claim forms or proof of loss (except in the case of out-of-area emergencies). Member must enroll with a General Dentist. Fac ID is used to indicate which facility a member chooses.


SELECT PLAN 1 DENTIST DIRECTORY<br />

Dentists listed are under contract as of 10/1/12<br />

Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />

Barnes Willie 068522 Family Dentistry 4896 Nittany Valley Dr, Box 397 Lamar PA 16848 General <strong>Provider</strong> Clinton<br />

* Patchin Harry 001712 Harry V Patchin DMD 407 S 32nd St Camp Hill PA 17011 General <strong>Provider</strong> Cumberland<br />

Gensbigler Joseph 002527 West Shore Family Dentistry, LTD 40 North 36th Street Camp Hill PA 17011 General <strong>Provider</strong> Cumberland<br />

Gensbigler Thomas 002527 West Shore Family Dentistry, LTD 40 North 36th Street Camp Hill PA 17011 General <strong>Provider</strong> Cumberland<br />

Yelk Peter 002527 West Shore Family Dentistry, LTD 40 North 36th Street Camp Hill PA 17011 General <strong>Provider</strong> Cumberland<br />

Babameto Blendi 050403 Aspen <strong>Dental</strong> 6416 Carlisle Pike, Suite 500 Mechanicsburg PA 17050 Oral Surgeon Cumberland<br />

Ciarallo Robert 050403 Aspen <strong>Dental</strong> 6416 Carlisle Pike, Suite 500 Mechanicsburg PA 17050 Oral Surgeon Cumberland<br />

Desai Jagruti 050403 Aspen <strong>Dental</strong> 6416 Carlisle Pike, Suite 500 Mechanicsburg PA 17050 General <strong>Provider</strong> Cumberland<br />

Kaur Kamaljit 050403 Aspen <strong>Dental</strong> 6416 Carlisle Pike, Suite 500 Mechanicsburg PA 17050 General <strong>Provider</strong> Cumberland<br />

Kuleva Juliana 050403 Aspen <strong>Dental</strong> 6416 Carlisle Pike, Suite 500 Mechanicsburg PA 17050 General <strong>Provider</strong> Cumberland<br />

Popernack John 050403 Aspen <strong>Dental</strong> 6416 Carlisle Pike, Suite 500 Mechanicsburg PA 17050 General <strong>Provider</strong> Cumberland<br />

Talati Ankit 050403 Aspen <strong>Dental</strong> 6416 Carlisle Pike, Suite 500 Mechanicsburg PA 17050 General <strong>Provider</strong> Cumberland<br />

Withanachchi Janatha 050403 Aspen <strong>Dental</strong> 6416 Carlisle Pike, Suite 500 Mechanicsburg PA 17050 Endodontist Cumberland<br />

Lahar Craig 001438 Craig E. Lahar, DMD OMS, P.C. 200 Cumberland Parkway Mechanicsburg PA 17055 Oral Surgeon Cumberland<br />

* Reese Terry 001476 Drs. Warren and Reese 324 E. Main Street Mechanicsburg PA 17055 General <strong>Provider</strong> Cumberland<br />

* Warren William 001476 Drs. Warren and Reese 324 E. Main Street Mechanicsburg PA 17055 General <strong>Provider</strong> Cumberland<br />

Patel Prafulchandra 050512 American <strong>Dental</strong> Care LLC 4811 Jonestown Rd, Suite 129 Harrisburg PA 17109 General <strong>Provider</strong> Dauphin<br />

Parikh Yogeshi 002773 Uptown Family Dentistry 2626 N 3rd Street, Suite3C Harrisburg PA 17110 General <strong>Provider</strong> Dauphin<br />

Ramos Jesus 002773 Uptown Family Dentistry 2626 N 3rd Street, Suite3C Harrisburg PA 17110 General <strong>Provider</strong> Dauphin<br />

Babameto Blendi 002749 Aspen <strong>Dental</strong> Associates of NY, PC 4265 Union Deposit Rd. Harrisburg PA 17111 Oral Surgeon Dauphin<br />

Butler Deborah 002749 Aspen <strong>Dental</strong> Associates of NY, PC 4265 Union Deposit Rd. Harrisburg PA 17111 General <strong>Provider</strong> Dauphin<br />

Ciarallo Robert 002749 Aspen <strong>Dental</strong> Associates of NY, PC 4265 Union Deposit Rd. Harrisburg PA 17111 Oral Surgeon Dauphin<br />

Desai Jagruti 002749 Aspen <strong>Dental</strong> Associates of NY, PC 4265 Union Deposit Rd. Harrisburg PA 17111 General <strong>Provider</strong> Dauphin<br />

Kaur Kamaljit 002749 Aspen <strong>Dental</strong> Associates of NY, PC 4265 Union Deposit Rd. Harrisburg PA 17111 General <strong>Provider</strong> Dauphin<br />

Kuleva Juliana 002749 Aspen <strong>Dental</strong> Associates of NY, PC 4265 Union Deposit Rd. Harrisburg PA 17111 General <strong>Provider</strong> Dauphin<br />

Popernack John 002749 Aspen <strong>Dental</strong> Associates of NY, PC 4265 Union Deposit Rd. Harrisburg PA 17111 General <strong>Provider</strong> Dauphin<br />

Talati Ankit 002749 Aspen <strong>Dental</strong> Associates of NY, PC 4265 Union Deposit Rd. Harrisburg PA 17111 General <strong>Provider</strong> Dauphin<br />

Withanachchi Janatha 002749 Aspen <strong>Dental</strong> Associates of NY, PC 4265 Union Deposit Rd. Harrisburg PA 17111 Endodontist Dauphin<br />

Watson John 001346 John J. Watson, D.D.S. 4707 Derry St. Harrisburg PA 17111 General <strong>Provider</strong> Dauphin<br />

Wojdylak Michael 000982 Michael Wojdylak, D.D.S. 61 Roosevelt Blvd, Suite 4 Harrisburg PA 17111 General <strong>Provider</strong> Dauphin<br />

Yoffe John 002230 John A. Yoffe, D.M.D. 2213 Forest Hills Drive Harrisburg PA 17112 Orthodontist Dauphin<br />

Dinello Donald 002193 Mid-Penn Oral Surgery 2201 Dover Rd Harrisburg PA 17112 Oral Surgeon Dauphin<br />

Rajchel Jeffrey 002193 Mid-Penn Oral Surgery 2201 Dover Rd Harrisburg PA 17112 Oral Surgeon Dauphin<br />

Patel Prafulchandra 001905 American <strong>Dental</strong> Care, L.L.C. 1135 E Chocolate Ave, Suite 101 Hershey PA 17033 General <strong>Provider</strong> Dauphin<br />

Patel Bhargav 069972 Hershey <strong>Dental</strong> Care 555 E Chocolate Ave Hershey PA 17033 General <strong>Provider</strong> Dauphin<br />

Jackson Carl 001528 Aston Family <strong>Dental</strong> Care 3200 Concord Rd., Ste.200 Aston PA 19014 General <strong>Provider</strong> Delaware<br />

Smith Alan 000840 Alan Jeffrey Smith, D.M.D. 130 E. Brookhaven Rd. Brookhaven PA 19015 General <strong>Provider</strong> Delaware<br />

Tewari Dinesh 069538 Brookhaven Family Dentistry 4 W Brookhaven Rd Brookhaven PA 19015 General <strong>Provider</strong> Delaware<br />

Panossian Antoine 070975 A+ Oral Surgery Specialty Care PC 8 Ponds Edge Dr, Suite 2 Chadds Ford PA 19317 Oral Surgeon Delaware<br />

Tran David 070975 A+ Oral Surgery Specialty Care PC 8 Ponds Edge Dr, Suite 2 Chadds Ford PA 19317 Oral Surgeon Delaware<br />

Bandelac Georges 070949 A+ Periodontic Specialty Care PC 8 Ponds Edge Dr, Suite 2 Chadds Ford PA 19317 Periodontist Delaware<br />

Evans Marianna 070949 A+ Periodontic Specialty Care PC 8 Ponds Edge Dr, Suite 2 Chadds Ford PA 19317 Periodontist Delaware<br />

Agrawal Avanti 002356 Advanced Family Dentistry PC 8 Pond's Edge Drive, Suite 2 Chadds Ford PA 19317 General <strong>Provider</strong> Delaware<br />

Ahmadzadeh Bijan 002356 Advanced Family Dentistry PC 8 Pond's Edge Drive, Suite 2 Chadds Ford PA 19317 General <strong>Provider</strong> Delaware<br />

Cho Woohyun 002356 Advanced Family Dentistry PC 8 Pond's Edge Drive, Suite 2 Chadds Ford PA 19317 General <strong>Provider</strong> Delaware<br />

Dapkute Ingrida 002356 Advanced Family Dentistry PC 8 Pond's Edge Drive, Suite 2 Chadds Ford PA 19317 General <strong>Provider</strong> Delaware<br />

Derosa Daniel 002356 Advanced Family Dentistry PC 8 Pond's Edge Drive, Suite 2 Chadds Ford PA 19317 General <strong>Provider</strong> Delaware<br />

Desai Kaushal 002356 Advanced Family Dentistry PC 8 Pond's Edge Drive, Suite 2 Chadds Ford PA 19317 General <strong>Provider</strong> Delaware<br />

Gombar Anna 002356 Advanced Family Dentistry PC 8 Pond's Edge Drive, Suite 2 Chadds Ford PA 19317 General <strong>Provider</strong> Delaware<br />

Kopp Anatoliy 002356 Advanced Family Dentistry PC 8 Pond's Edge Drive, Suite 2 Chadds Ford PA 19317 General <strong>Provider</strong> Delaware<br />

Lee Young 002356 Advanced Family Dentistry PC 8 Pond's Edge Drive, Suite 2 Chadds Ford PA 19317 General <strong>Provider</strong> Delaware<br />

Merin Jared 002356 Advanced Family Dentistry PC 8 Pond's Edge Drive, Suite 2 Chadds Ford PA 19317 General <strong>Provider</strong> Delaware<br />

Mitelman Alexandra 002356 Advanced Family Dentistry PC 8 Pond's Edge Drive, Suite 2 Chadds Ford PA 19317 General <strong>Provider</strong> Delaware<br />

Moriarty Sean 002356 Advanced Family Dentistry PC 8 Pond's Edge Drive, Suite 2 Chadds Ford PA 19317 General <strong>Provider</strong> Delaware<br />

Savani Bhaskar 002356 Advanced Family Dentistry PC 8 Pond's Edge Drive, Suite 2 Chadds Ford PA 19317 General <strong>Provider</strong> Delaware<br />

Savani Bhumi 002356 Advanced Family Dentistry PC 8 Pond's Edge Drive, Suite 2 Chadds Ford PA 19317 General <strong>Provider</strong> Delaware<br />

Savani Niranjan 002356 Advanced Family Dentistry PC 8 Pond's Edge Drive, Suite 2 Chadds Ford PA 19317 General <strong>Provider</strong> Delaware<br />

Singh Jagdeep 002356 Advanced Family Dentistry PC 8 Pond's Edge Drive, Suite 2 Chadds Ford PA 19317 General <strong>Provider</strong> Delaware<br />

Todd Meredith 002356 Advanced Family Dentistry PC 8 Pond's Edge Drive, Suite 2 Chadds Ford PA 19317 General <strong>Provider</strong> Delaware<br />

Yoon Jaewon 002356 Advanced Family Dentistry PC 8 Pond's Edge Drive, Suite 2 Chadds Ford PA 19317 General <strong>Provider</strong> Delaware<br />

Turk Albert 001446 Albert Turk, D.M.D 127 Wilmington West, Chester Pike Chadds Ford PA 19317 General <strong>Provider</strong> Delaware<br />

Charkas Ahmad 070956 Allied Orthodontics PC 8 Ponds Edge Dr, Suite 2 Chadds Ford PA 19317 Orthodontist Delaware<br />

Evans Marianna 070956 Allied Orthodontics PC 8 Ponds Edge Dr, Suite 2 Chadds Ford PA 19317 Orthodontist Delaware<br />

Barboza Maria Helena 033848 Centre for Cosmetic Dentistry 275 Wilmington Westchester Pk, Ste. 111 Chadds Ford PA 19317 General <strong>Provider</strong> Delaware<br />

Hayes Richard 000662 Orthodontic Associates 3920 Pyle Road Chadds Ford PA 19317 Orthodontist Delaware<br />

DePanicis Vincent 002003 ChesPenn Health <strong>Services</strong> 125 E 9th Street Chester PA 19013 General <strong>Provider</strong> Delaware<br />

* Indicates dentist that is accepting current patients only.<br />

All <strong>Select</strong> <strong>Plan</strong> Dentists Page 22<br />

1 Same as a DHMO with fixed member copayments, no annual maximum dollar limits, no waiting periods, no deductibles, no pre-authorization paperwork or pre-treatment estimates and no<br />

claim forms or proof of loss (except in the case of out-of-area emergencies). Member must enroll with a General Dentist. Fac ID is used to indicate which facility a member chooses.


SELECT PLAN 1 DENTIST DIRECTORY<br />

Dentists listed are under contract as of 10/1/12<br />

Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />

DePanicis Vincent 002004 ChesPenn Health <strong>Services</strong> 2602 West 9th Street Chester PA 19013 General <strong>Provider</strong> Delaware<br />

Kane Michael 002003 ChesPenn Health <strong>Services</strong> 125 E 9th Street Chester PA 19013 General <strong>Provider</strong> Delaware<br />

Kane Michael 002004 ChesPenn Health <strong>Services</strong> 2602 West 9th Street Chester PA 19013 General <strong>Provider</strong> Delaware<br />

Koshetar Nancy 002003 ChesPenn Health <strong>Services</strong> 125 E 9th Street Chester PA 19013 General <strong>Provider</strong> Delaware<br />

Koshetar Nancy 002004 ChesPenn Health <strong>Services</strong> 2602 West 9th Street Chester PA 19013 General <strong>Provider</strong> Delaware<br />

Tran Alyssa Dieu Tra 002003 ChesPenn Health <strong>Services</strong> 125 E 9th Street Chester PA 19013 General <strong>Provider</strong> Delaware<br />

Tran Alyssa Dieu Tra 002004 ChesPenn Health <strong>Services</strong> 2602 West 9th Street Chester PA 19013 General <strong>Provider</strong> Delaware<br />

Belkin Philip 001453 The Saltz <strong>Dental</strong> Center 616 Avenue of the States Chester PA 19013 General <strong>Provider</strong> Delaware<br />

Cooper Howard 001453 The Saltz <strong>Dental</strong> Center 616 Avenue of the States Chester PA 19013 General <strong>Provider</strong> Delaware<br />

Dhruva Ashvinskumar 001453 The Saltz <strong>Dental</strong> Center 616 Avenue of the States Chester PA 19013 General <strong>Provider</strong> Delaware<br />

Marinchak Michael 001453 The Saltz <strong>Dental</strong> Center 616 Avenue of the States Chester PA 19013 General <strong>Provider</strong> Delaware<br />

Sanfacon Dennis 001453 The Saltz <strong>Dental</strong> Center 616 Avenue of the States Chester PA 19013 General <strong>Provider</strong> Delaware<br />

Spevak Joseph 001453 The Saltz <strong>Dental</strong> Center 616 Avenue of the States Chester PA 19013 General <strong>Provider</strong> Delaware<br />

Bahram Ramin 078258 Oral Surgery Consultants of PA 151 South Springfield Road Clifton Heights PA 19018 Oral Surgeon Delaware<br />

Bowser Daniel 078258 Oral Surgery Consultants of PA 151 South Springfield Road Clifton Heights PA 19018 Oral Surgeon Delaware<br />

Richman Brad 078258 Oral Surgery Consultants of PA 151 South Springfield Road Clifton Heights PA 19018 Oral Surgeon Delaware<br />

Kabil Abdallah 002127 Hollyland <strong>Dental</strong> Center 917 MacDade Blvd Collingdale PA 19023 General <strong>Provider</strong> Delaware<br />

Clark Tanner 015469 Ameri <strong>Dental</strong> Group PC 875 Main Street Darby PA 19023 General <strong>Provider</strong> Delaware<br />

Patel Amish 015469 Ameri <strong>Dental</strong> Group PC 875 Main Street Darby PA 19023 General <strong>Provider</strong> Delaware<br />

Patel Prafulchandra 015469 Ameri <strong>Dental</strong> Group PC 875 Main Street Darby PA 19023 General <strong>Provider</strong> Delaware<br />

Tewari Dinesh 069540 Drexel Hill Family Dentistry PC 4244 Ferne Blvd Drexel Hill PA 19026 General <strong>Provider</strong> Delaware<br />

Kaye Melvin 000752 Melvin A Kaye DDS 2237 Garrett Rd. Drexel Hill PA 19026 Endodontist Delaware<br />

Bahram Ramin 078259 Oral Surgery Consultants of PA 720 Macdade Boulevard Folsom PA 19033 Oral Surgeon Delaware<br />

Bowser Daniel 078259 Oral Surgery Consultants of PA 720 Macdade Boulevard Folsom PA 19033 Oral Surgeon Delaware<br />

Richman Brad 078259 Oral Surgery Consultants of PA 720 Macdade Boulevard Folsom PA 19033 Oral Surgeon Delaware<br />

Mongiovi Vincent 002234 Mongiovi Orthodontics 4 Woodland Drive Glen Mills PA 19342 Orthodontist Delaware<br />

Wadenya Rose 081804 Eagle Crest Pediatric Dentistry 31 S Eagle Rd, Suite 100 Havertown PA 19083 Pedodontist Delaware<br />

Wank Harvey 000824 Harvey A. Wank, D.M.D. 525 West Chester Pike, Suite 100 Havertown PA 19083 Oral Surgeon Delaware<br />

Shafagh Iraj 001320 Iraj Shafagh, D.M.D. 109 North Eagle Rd. Havertown PA 19083 General <strong>Provider</strong> Delaware<br />

Mostatab Rebecca 002140 Smile By Design 1330 W Chester Pike Havertown PA 19083 General <strong>Provider</strong> Delaware<br />

Cooper Joel 000992 Ameri <strong>Dental</strong> Group PC 43 S Lansdowne Ave. Lansdowne PA 19050 General <strong>Provider</strong> Delaware<br />

Patel Amish 000992 Ameri <strong>Dental</strong> Group PC 43 S Lansdowne Ave. Lansdowne PA 19050 General <strong>Provider</strong> Delaware<br />

Patel Prafulchandra 000992 Ameri <strong>Dental</strong> Group PC 43 S Lansdowne Ave. Lansdowne PA 19050 General <strong>Provider</strong> Delaware<br />

Adams Michael 002801 American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 General <strong>Provider</strong> Delaware<br />

Blumenthal Edan 002801 American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 General <strong>Provider</strong> Delaware<br />

Blumenthal Mitchel 002801 American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 General <strong>Provider</strong> Delaware<br />

Bruno Frank 002801 American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 Endodontist Delaware<br />

Chen Yang 002801 American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 General <strong>Provider</strong> Delaware<br />

Cohen Hal 002801 American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 General <strong>Provider</strong> Delaware<br />

Daly Gerald 002801 American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 General <strong>Provider</strong> Delaware<br />

David Dan 002801 American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 General <strong>Provider</strong> Delaware<br />

Edmonds R Blake 002801 American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 General <strong>Provider</strong> Delaware<br />

Elkhatib Mohammad 002801 American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 General <strong>Provider</strong> Delaware<br />

Fluhr Howard 002801 American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 General <strong>Provider</strong> Delaware<br />

Gelbart Steven 002801 American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 General <strong>Provider</strong> Delaware<br />

Gilkey William 002801 American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 General <strong>Provider</strong> Delaware<br />

Khan Aliya 002801 American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 General <strong>Provider</strong> Delaware<br />

Kim Jae Woo 002801 American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 General <strong>Provider</strong> Delaware<br />

Kim Steven 002801 American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 Periodontist Delaware<br />

Koff Howard 002801 American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 Orthodontist Delaware<br />

Levy Jamie 002801 American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 Oral Surgeon Delaware<br />

Li Fuming 002801 American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 General <strong>Provider</strong> Delaware<br />

Lu John 002801 American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 Periodontist Delaware<br />

Mojahed Amir 002801 American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 General <strong>Provider</strong> Delaware<br />

Mumtaz Samera 002801 American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 General <strong>Provider</strong> Delaware<br />

Nguyen Diep 002801 American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 General <strong>Provider</strong> Delaware<br />

Oh Jinsuk 002801 American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 General <strong>Provider</strong> Delaware<br />

Parakhoodi Shabnam 002801 American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 General <strong>Provider</strong> Delaware<br />

Pereia Christine 002801 American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 General <strong>Provider</strong> Delaware<br />

Roth Michael 002801 American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 Orthodontist Delaware<br />

Ruggieri John 002801 American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 General <strong>Provider</strong> Delaware<br />

Sacks Frederick 002801 American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 Oral Surgeon Delaware<br />

Sandhu Satinder 002801 American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 General <strong>Provider</strong> Delaware<br />

Sanfacon Dennis 002801 American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 General <strong>Provider</strong> Delaware<br />

Shah Nishit 002801 American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 General <strong>Provider</strong> Delaware<br />

Sultana Parveen 002801 American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 General <strong>Provider</strong> Delaware<br />

* Indicates dentist that is accepting current patients only.<br />

All <strong>Select</strong> <strong>Plan</strong> Dentists Page 23<br />

1 Same as a DHMO with fixed member copayments, no annual maximum dollar limits, no waiting periods, no deductibles, no pre-authorization paperwork or pre-treatment estimates and no<br />

claim forms or proof of loss (except in the case of out-of-area emergencies). Member must enroll with a General Dentist. Fac ID is used to indicate which facility a member chooses.


SELECT PLAN 1 DENTIST DIRECTORY<br />

Dentists listed are under contract as of 10/1/12<br />

Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />

Thilak Preetha 002801 American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 General <strong>Provider</strong> Delaware<br />

Weinstein Steven 002801 American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 General <strong>Provider</strong> Delaware<br />

Yang Qing 002801 American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 General <strong>Provider</strong> Delaware<br />

Yao Zheng 002801 American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 General <strong>Provider</strong> Delaware<br />

Yoon Simon 002801 American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 General <strong>Provider</strong> Delaware<br />

Bresler David 025052 David A Bresler DDS PC 1003 West Baltimore Pike Media PA 19063 Pedodontist Delaware<br />

Bresler Jason 025052 David A Bresler DDS PC 1003 West Baltimore Pike Media PA 19063 Pedodontist Delaware<br />

Bresler Joshua 025052 David A Bresler DDS PC 1003 West Baltimore Pike Media PA 19063 Pedodontist Delaware<br />

Mayzenberg Julia 025052 David A Bresler DDS PC 1003 West Baltimore Pike Media PA 19063 Pedodontist Delaware<br />

Kahlon Sonia 050566 Rich Family Orthodontics 1022 E Baltimore Pike Media PA 19063 Orthodontist Delaware<br />

Rich Jeremy 050566 Rich Family Orthodontics 1022 E Baltimore Pike Media PA 19063 Orthodontist Delaware<br />

Panossian Antoine 070973 A+ Oral Surgery Specialty Care PC 35 B Woodland Ave Morton PA 19070 Oral Surgeon Delaware<br />

Tran David 070973 A+ Oral Surgery Specialty Care PC 35 B Woodland Ave Morton PA 19070 Oral Surgeon Delaware<br />

Bandelac Georges 070946 A+ Periodontic Specialty Care PC 35 B Woodland Ave Morton PA 19070 Periodontist Delaware<br />

Evans Marianna 070946 A+ Periodontic Specialty Care PC 35 B Woodland Ave Morton PA 19070 Periodontist Delaware<br />

Agrawal Avanti 002354 Advanced Family Dentistry PC 35 B Woodland Avenue Morton PA 19070 General <strong>Provider</strong> Delaware<br />

Ahmadzadeh Bijan 002354 Advanced Family Dentistry PC 35 B Woodland Avenue Morton PA 19070 General <strong>Provider</strong> Delaware<br />

Dapkute Ingrida 002354 Advanced Family Dentistry PC 35 B Woodland Avenue Morton PA 19070 General <strong>Provider</strong> Delaware<br />

Derosa Daniel 002354 Advanced Family Dentistry PC 35 B Woodland Avenue Morton PA 19070 General <strong>Provider</strong> Delaware<br />

Desai Kaushal 002354 Advanced Family Dentistry PC 35 B Woodland Avenue Morton PA 19070 General <strong>Provider</strong> Delaware<br />

Gombar Anna 002354 Advanced Family Dentistry PC 35 B Woodland Avenue Morton PA 19070 General <strong>Provider</strong> Delaware<br />

Kopp Anatoliy 002354 Advanced Family Dentistry PC 35 B Woodland Avenue Morton PA 19070 General <strong>Provider</strong> Delaware<br />

Merin Jared 002354 Advanced Family Dentistry PC 35 B Woodland Avenue Morton PA 19070 General <strong>Provider</strong> Delaware<br />

Mitelman Alexandra 002354 Advanced Family Dentistry PC 35 B Woodland Avenue Morton PA 19070 General <strong>Provider</strong> Delaware<br />

Moriarty Sean 002354 Advanced Family Dentistry PC 35 B Woodland Avenue Morton PA 19070 General <strong>Provider</strong> Delaware<br />

Savani Bhaskar 002354 Advanced Family Dentistry PC 35 B Woodland Avenue Morton PA 19070 General <strong>Provider</strong> Delaware<br />

Savani Bhumi 002354 Advanced Family Dentistry PC 35 B Woodland Avenue Morton PA 19070 General <strong>Provider</strong> Delaware<br />

Savani Niranjan 002354 Advanced Family Dentistry PC 35 B Woodland Avenue Morton PA 19070 General <strong>Provider</strong> Delaware<br />

Sitkovetsky Mikhail 002354 Advanced Family Dentistry PC 35 B Woodland Avenue Morton PA 19070 General <strong>Provider</strong> Delaware<br />

Srivastava Rani 002354 Advanced Family Dentistry PC 35 B Woodland Avenue Morton PA 19070 General <strong>Provider</strong> Delaware<br />

Todd Meredith 002354 Advanced Family Dentistry PC 35 B Woodland Avenue Morton PA 19070 General <strong>Provider</strong> Delaware<br />

Wang Lin 002354 Advanced Family Dentistry PC 35 B Woodland Avenue Morton PA 19070 General <strong>Provider</strong> Delaware<br />

Bresler David 050961 Doc Breslers Cavity Busters 4659 West Chester Pike Newtown Square PA 19073 Pedodontist Delaware<br />

Bresler Jason 050961 Doc Breslers Cavity Busters 4659 West Chester Pike Newtown Square PA 19073 Pedodontist Delaware<br />

Bresler Joshua 050961 Doc Breslers Cavity Busters 4659 West Chester Pike Newtown Square PA 19073 Pedodontist Delaware<br />

Mayzenberg Julia 050961 Doc Breslers Cavity Busters 4659 West Chester Pike Newtown Square PA 19073 Pedodontist Delaware<br />

Zito Domenico 000668 Domenico Zito, D.M.D. 3400 W Chester Pike, Suite 850 Newtown Square PA 19073 Periodontist Delaware<br />

Dow Najibe 069534 Najibe H Dow DMD Family Dentistry 3111 West Chester Pike Newtown Square PA 19073 General <strong>Provider</strong> Delaware<br />

Tewari Dinesh 069539 Norwood Family Dentistry 7 W Winona Ave Norwood PA 19074 General <strong>Provider</strong> Delaware<br />

Shore Jeffrey 000361 Shore & Snyder <strong>Dental</strong> Center 519 Chester Pike, Box 40 Norwood PA 19074 General <strong>Provider</strong> Delaware<br />

Snyder Mark 000361 Shore & Snyder <strong>Dental</strong> Center 519 Chester Pike, Box 40 Norwood PA 19074 General <strong>Provider</strong> Delaware<br />

Hayes Richard 000664 Orthodontic Associates 101 Dutton Street Ridley Park PA 19078 Orthodontist Delaware<br />

Adams Michael 002794 American <strong>Dental</strong> Care, PC 515 Baltimore Pike Springfield PA 19064 General <strong>Provider</strong> Delaware<br />

Bruno Frank 002794 American <strong>Dental</strong> Care, PC 515 Baltimore Pike Springfield PA 19064 Endodontist Delaware<br />

Chen Yang 002794 American <strong>Dental</strong> Care, PC 515 Baltimore Pike Springfield PA 19064 General <strong>Provider</strong> Delaware<br />

Cohen Hal 002794 American <strong>Dental</strong> Care, PC 515 Baltimore Pike Springfield PA 19064 General <strong>Provider</strong> Delaware<br />

Daly Gerald 002794 American <strong>Dental</strong> Care, PC 515 Baltimore Pike Springfield PA 19064 General <strong>Provider</strong> Delaware<br />

David Dan 002794 American <strong>Dental</strong> Care, PC 515 Baltimore Pike Springfield PA 19064 General <strong>Provider</strong> Delaware<br />

Edmonds R Blake 002794 American <strong>Dental</strong> Care, PC 515 Baltimore Pike Springfield PA 19064 General <strong>Provider</strong> Delaware<br />

Elkhatib Mohammad 002794 American <strong>Dental</strong> Care, PC 515 Baltimore Pike Springfield PA 19064 General <strong>Provider</strong> Delaware<br />

Fluhr Howard 002794 American <strong>Dental</strong> Care, PC 515 Baltimore Pike Springfield PA 19064 General <strong>Provider</strong> Delaware<br />

Gelbart Steven 002794 American <strong>Dental</strong> Care, PC 515 Baltimore Pike Springfield PA 19064 General <strong>Provider</strong> Delaware<br />

Kim Jae Woo 002794 American <strong>Dental</strong> Care, PC 515 Baltimore Pike Springfield PA 19064 General <strong>Provider</strong> Delaware<br />

Kim Steven 002794 American <strong>Dental</strong> Care, PC 515 Baltimore Pike Springfield PA 19064 Periodontist Delaware<br />

Koff Howard 002794 American <strong>Dental</strong> Care, PC 515 Baltimore Pike Springfield PA 19064 Orthodontist Delaware<br />

Levy Jamie 002794 American <strong>Dental</strong> Care, PC 515 Baltimore Pike Springfield PA 19064 Oral Surgeon Delaware<br />

Li Fuming 002794 American <strong>Dental</strong> Care, PC 515 Baltimore Pike Springfield PA 19064 General <strong>Provider</strong> Delaware<br />

Lu John 002794 American <strong>Dental</strong> Care, PC 515 Baltimore Pike Springfield PA 19064 Periodontist Delaware<br />

Mojahed Amir 002794 American <strong>Dental</strong> Care, PC 515 Baltimore Pike Springfield PA 19064 General <strong>Provider</strong> Delaware<br />

Mumtaz Samera 002794 American <strong>Dental</strong> Care, PC 515 Baltimore Pike Springfield PA 19064 General <strong>Provider</strong> Delaware<br />

Nguyen Diep 002794 American <strong>Dental</strong> Care, PC 515 Baltimore Pike Springfield PA 19064 General <strong>Provider</strong> Delaware<br />

Oh Jinsuk 002794 American <strong>Dental</strong> Care, PC 515 Baltimore Pike Springfield PA 19064 General <strong>Provider</strong> Delaware<br />

Pereia Christine 002794 American <strong>Dental</strong> Care, PC 515 Baltimore Pike Springfield PA 19064 General <strong>Provider</strong> Delaware<br />

Roth Michael 002794 American <strong>Dental</strong> Care, PC 515 Baltimore Pike Springfield PA 19064 Orthodontist Delaware<br />

Ruggieri John 002794 American <strong>Dental</strong> Care, PC 515 Baltimore Pike Springfield PA 19064 General <strong>Provider</strong> Delaware<br />

Sandhu Satinder 002794 American <strong>Dental</strong> Care, PC 515 Baltimore Pike Springfield PA 19064 General <strong>Provider</strong> Delaware<br />

* Indicates dentist that is accepting current patients only.<br />

All <strong>Select</strong> <strong>Plan</strong> Dentists Page 24<br />

1 Same as a DHMO with fixed member copayments, no annual maximum dollar limits, no waiting periods, no deductibles, no pre-authorization paperwork or pre-treatment estimates and no<br />

claim forms or proof of loss (except in the case of out-of-area emergencies). Member must enroll with a General Dentist. Fac ID is used to indicate which facility a member chooses.


SELECT PLAN 1 DENTIST DIRECTORY<br />

Dentists listed are under contract as of 10/1/12<br />

Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />

Sanfacon Dennis 002794 American <strong>Dental</strong> Care, PC 515 Baltimore Pike Springfield PA 19064 General <strong>Provider</strong> Delaware<br />

Shah Nishit 002794 American <strong>Dental</strong> Care, PC 515 Baltimore Pike Springfield PA 19064 General <strong>Provider</strong> Delaware<br />

Sultana Parveen 002794 American <strong>Dental</strong> Care, PC 515 Baltimore Pike Springfield PA 19064 General <strong>Provider</strong> Delaware<br />

Thilak Preetha 002794 American <strong>Dental</strong> Care, PC 515 Baltimore Pike Springfield PA 19064 General <strong>Provider</strong> Delaware<br />

Weinstein Steven 002794 American <strong>Dental</strong> Care, PC 515 Baltimore Pike Springfield PA 19064 General <strong>Provider</strong> Delaware<br />

Yang Qing 002794 American <strong>Dental</strong> Care, PC 515 Baltimore Pike Springfield PA 19064 General <strong>Provider</strong> Delaware<br />

Yao Zheng 002794 American <strong>Dental</strong> Care, PC 515 Baltimore Pike Springfield PA 19064 General <strong>Provider</strong> Delaware<br />

Yoon Simon 002794 American <strong>Dental</strong> Care, PC 515 Baltimore Pike Springfield PA 19064 General <strong>Provider</strong> Delaware<br />

Hayes Richard 000663 Orthodontic Associates 1050 Baltimore Pike Springfield PA 19064 Orthodontist Delaware<br />

Adams Michael 002795 American <strong>Dental</strong> Care, PC 6780 Market Street Upper Darby PA 19082 General <strong>Provider</strong> Delaware<br />

Bruno Frank 002795 American <strong>Dental</strong> Care, PC 6780 Market Street Upper Darby PA 19082 Endodontist Delaware<br />

Chen Yang 002795 American <strong>Dental</strong> Care, PC 6780 Market Street Upper Darby PA 19082 General <strong>Provider</strong> Delaware<br />

Cohen Hal 002795 American <strong>Dental</strong> Care, PC 6780 Market Street Upper Darby PA 19082 General <strong>Provider</strong> Delaware<br />

Daly Gerald 002795 American <strong>Dental</strong> Care, PC 6780 Market Street Upper Darby PA 19082 General <strong>Provider</strong> Delaware<br />

David Dan 002795 American <strong>Dental</strong> Care, PC 6780 Market Street Upper Darby PA 19082 General <strong>Provider</strong> Delaware<br />

Edmonds R Blake 002795 American <strong>Dental</strong> Care, PC 6780 Market Street Upper Darby PA 19082 General <strong>Provider</strong> Delaware<br />

Elkhatib Mohammad 002795 American <strong>Dental</strong> Care, PC 6780 Market Street Upper Darby PA 19082 General <strong>Provider</strong> Delaware<br />

Fluhr Howard 002795 American <strong>Dental</strong> Care, PC 6780 Market Street Upper Darby PA 19082 General <strong>Provider</strong> Delaware<br />

Gelbart Steven 002795 American <strong>Dental</strong> Care, PC 6780 Market Street Upper Darby PA 19082 General <strong>Provider</strong> Delaware<br />

Kim Jae Woo 002795 American <strong>Dental</strong> Care, PC 6780 Market Street Upper Darby PA 19082 General <strong>Provider</strong> Delaware<br />

Kim Steven 002795 American <strong>Dental</strong> Care, PC 6780 Market Street Upper Darby PA 19082 Periodontist Delaware<br />

Koff Howard 002795 American <strong>Dental</strong> Care, PC 6780 Market Street Upper Darby PA 19082 Orthodontist Delaware<br />

Levy Jamie 002795 American <strong>Dental</strong> Care, PC 6780 Market Street Upper Darby PA 19082 Oral Surgeon Delaware<br />

Li Fuming 002795 American <strong>Dental</strong> Care, PC 6780 Market Street Upper Darby PA 19082 General <strong>Provider</strong> Delaware<br />

Lu John 002795 American <strong>Dental</strong> Care, PC 6780 Market Street Upper Darby PA 19082 Periodontist Delaware<br />

Mojahed Amir 002795 American <strong>Dental</strong> Care, PC 6780 Market Street Upper Darby PA 19082 General <strong>Provider</strong> Delaware<br />

Mumtaz Samera 002795 American <strong>Dental</strong> Care, PC 6780 Market Street Upper Darby PA 19082 General <strong>Provider</strong> Delaware<br />

Nguyen Diep 002795 American <strong>Dental</strong> Care, PC 6780 Market Street Upper Darby PA 19082 General <strong>Provider</strong> Delaware<br />

Oh Jinsuk 002795 American <strong>Dental</strong> Care, PC 6780 Market Street Upper Darby PA 19082 General <strong>Provider</strong> Delaware<br />

Pereia Christine 002795 American <strong>Dental</strong> Care, PC 6780 Market Street Upper Darby PA 19082 General <strong>Provider</strong> Delaware<br />

Roth Michael 002795 American <strong>Dental</strong> Care, PC 6780 Market Street Upper Darby PA 19082 Orthodontist Delaware<br />

Ruggieri John 002795 American <strong>Dental</strong> Care, PC 6780 Market Street Upper Darby PA 19082 General <strong>Provider</strong> Delaware<br />

Sandhu Satinder 002795 American <strong>Dental</strong> Care, PC 6780 Market Street Upper Darby PA 19082 General <strong>Provider</strong> Delaware<br />

Sanfacon Dennis 002795 American <strong>Dental</strong> Care, PC 6780 Market Street Upper Darby PA 19082 General <strong>Provider</strong> Delaware<br />

Shah Nishit 002795 American <strong>Dental</strong> Care, PC 6780 Market Street Upper Darby PA 19082 General <strong>Provider</strong> Delaware<br />

Sultana Parveen 002795 American <strong>Dental</strong> Care, PC 6780 Market Street Upper Darby PA 19082 General <strong>Provider</strong> Delaware<br />

Thilak Preetha 002795 American <strong>Dental</strong> Care, PC 6780 Market Street Upper Darby PA 19082 General <strong>Provider</strong> Delaware<br />

Yang Qing 002795 American <strong>Dental</strong> Care, PC 6780 Market Street Upper Darby PA 19082 General <strong>Provider</strong> Delaware<br />

Yao Zheng 002795 American <strong>Dental</strong> Care, PC 6780 Market Street Upper Darby PA 19082 General <strong>Provider</strong> Delaware<br />

Yoon Simon 002795 American <strong>Dental</strong> Care, PC 6780 Market Street Upper Darby PA 19082 General <strong>Provider</strong> Delaware<br />

Joseph Zacharias 038068 Care <strong>Dental</strong> LLC 134 S State Rd Upper Darby PA 19082 General <strong>Provider</strong> Delaware<br />

Brown Glen 000498 Glenn A Brown, DMD 6776 Market Street Upper Darby PA 19082 General <strong>Provider</strong> Delaware<br />

Aftab Kanwal 068496 Pristine <strong>Dental</strong> LLC 392 Avon Rd Upper Darby PA 19082 General <strong>Provider</strong> Delaware<br />

Aranbayev Yefim 068496 Pristine <strong>Dental</strong> LLC 392 Avon Rd Upper Darby PA 19082 General <strong>Provider</strong> Delaware<br />

Mallya Rachel 000831 Rachel Mallya, D.M.D. 27 Garrett Road Upper Darby PA 19082 General <strong>Provider</strong> Delaware<br />

Gross Stephanie 000751 S. Harris Gross Wallingford Perio Center 9 N. Providence Rd., P.O. Box 81 Wallingford PA 19086 Periodontist Delaware<br />

Mostatab Rebecca 002740 Smile By Design 335 West Lancaster Ave Wayne PA 19087 General <strong>Provider</strong> Delaware<br />

Dhillon Upinder 070447 Complete <strong>Dental</strong> Care 1300 Macdade Blvd, Suite 5 Woodlyn PA 19094 General <strong>Provider</strong> Delaware<br />

Tewari Dinesh 079079 Yeadon Family Dentistry 724 Church Lane Yeadon PA 19050 General <strong>Provider</strong> Delaware<br />

D'Aurora Donald 001993 Community Health Net 1611 Peach Street, Suite 465 Erie PA 16501 General <strong>Provider</strong> Erie<br />

Graham-Kremers Ama 001993 Community Health Net 1611 Peach Street, Suite 465 Erie PA 16501 General <strong>Provider</strong> Erie<br />

Kinnear-Adams Suzanne 001993 Community Health Net 1611 Peach Street, Suite 465 Erie PA 16501 General <strong>Provider</strong> Erie<br />

Rick Andrea 001993 Community Health Net 1611 Peach Street, Suite 465 Erie PA 16501 General <strong>Provider</strong> Erie<br />

D'Aurora Donald 001982 Community Health Net 1720 Holland St Erie PA 16503 General <strong>Provider</strong> Erie<br />

Graham-Kremers Ama 001982 Community Health Net 1720 Holland St Erie PA 16503 General <strong>Provider</strong> Erie<br />

Rick Andrea 001982 Community Health Net 1720 Holland St Erie PA 16503 General <strong>Provider</strong> Erie<br />

Graham-Kremers Ama 033856 Community Health Net 2922 State Street Erie PA 16508 General <strong>Provider</strong> Erie<br />

Rick Andrea 033856 Community Health Net 2922 State Street Erie PA 16508 General <strong>Provider</strong> Erie<br />

Glecos Robert 037963 Aspen <strong>Dental</strong> Associates of NY., P.C. 2049 Interchange Rd Erie PA 16509 General <strong>Provider</strong> Erie<br />

Mohney Bryan 037963 Aspen <strong>Dental</strong> Associates of NY., P.C. 2049 Interchange Rd Erie PA 16509 General <strong>Provider</strong> Erie<br />

Aboosi Omar 002825 Aspen <strong>Dental</strong> of Western PA, PC 100 Pricedale Rd. Belle Vernon PA 15012 General <strong>Provider</strong> Fayette<br />

Bonczek Brian 002825 Aspen <strong>Dental</strong> of Western PA, PC 100 Pricedale Rd. Belle Vernon PA 15012 General <strong>Provider</strong> Fayette<br />

Ciarallo Robert 002825 Aspen <strong>Dental</strong> of Western PA, PC 100 Pricedale Rd. Belle Vernon PA 15012 Oral Surgeon Fayette<br />

Grinberg Anna 002825 Aspen <strong>Dental</strong> of Western PA, PC 100 Pricedale Rd. Belle Vernon PA 15012 General <strong>Provider</strong> Fayette<br />

Monaco Natalie 002825 Aspen <strong>Dental</strong> of Western PA, PC 100 Pricedale Rd. Belle Vernon PA 15012 General <strong>Provider</strong> Fayette<br />

Monios George 002825 Aspen <strong>Dental</strong> of Western PA, PC 100 Pricedale Rd. Belle Vernon PA 15012 General <strong>Provider</strong> Fayette<br />

* Indicates dentist that is accepting current patients only.<br />

All <strong>Select</strong> <strong>Plan</strong> Dentists Page 25<br />

1 Same as a DHMO with fixed member copayments, no annual maximum dollar limits, no waiting periods, no deductibles, no pre-authorization paperwork or pre-treatment estimates and no<br />

claim forms or proof of loss (except in the case of out-of-area emergencies). Member must enroll with a General Dentist. Fac ID is used to indicate which facility a member chooses.


SELECT PLAN 1 DENTIST DIRECTORY<br />

Dentists listed are under contract as of 10/1/12<br />

Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />

Noel Rubins 002825 Aspen <strong>Dental</strong> of Western PA, PC 100 Pricedale Rd. Belle Vernon PA 15012 General <strong>Provider</strong> Fayette<br />

Ruprecht Heather 002825 Aspen <strong>Dental</strong> of Western PA, PC 100 Pricedale Rd. Belle Vernon PA 15012 General <strong>Provider</strong> Fayette<br />

Shieh Andy 002825 Aspen <strong>Dental</strong> of Western PA, PC 100 Pricedale Rd. Belle Vernon PA 15012 General <strong>Provider</strong> Fayette<br />

Gates Durwin 001649 Durwin L. Gates, D.M.D. 956 Rostraver Road Belle Vernon PA 15012 General <strong>Provider</strong> Fayette<br />

Barron, Jr Edward 050915 Edward L Barron Jr DDS PC 1730 Rostraver Rd, PO Box 926 Belle Vernon PA 15012 General <strong>Provider</strong> Fayette<br />

Balasubramaniam Ravi 001365 Laurel Highlands Family Dentistry 1952 University Drive Connellsville PA 15425 General <strong>Provider</strong> Fayette<br />

Grimaldi Richard 002573 Richard A. Grimaldi, DMD and Associates 320 Memorial Blvd. Connellsville PA 15425 General <strong>Provider</strong> Fayette<br />

Grimaldi-Farrah Ashleigh 002573 Richard A. Grimaldi, DMD and Associates 320 Memorial Blvd. Connellsville PA 15425 General <strong>Provider</strong> Fayette<br />

Check Jennifer 038052 Aspen <strong>Dental</strong> 201 Walmart Dr Uniontown PA 15401 General <strong>Provider</strong> Fayette<br />

Ciarallo Robert 038052 Aspen <strong>Dental</strong> 201 Walmart Dr Uniontown PA 15401 Oral Surgeon Fayette<br />

Cignetti Scott 038052 Aspen <strong>Dental</strong> 201 Walmart Dr Uniontown PA 15401 General <strong>Provider</strong> Fayette<br />

Fazio John 038052 Aspen <strong>Dental</strong> 201 Walmart Dr Uniontown PA 15401 General <strong>Provider</strong> Fayette<br />

Ferguson III William 038052 Aspen <strong>Dental</strong> 201 Walmart Dr Uniontown PA 15401 General <strong>Provider</strong> Fayette<br />

Grinberg Anna 038052 Aspen <strong>Dental</strong> 201 Walmart Dr Uniontown PA 15401 General <strong>Provider</strong> Fayette<br />

Malone Matthew 038052 Aspen <strong>Dental</strong> 201 Walmart Dr Uniontown PA 15401 General <strong>Provider</strong> Fayette<br />

McCann Eve 038052 Aspen <strong>Dental</strong> 201 Walmart Dr Uniontown PA 15401 General <strong>Provider</strong> Fayette<br />

McClain Kelly 038052 Aspen <strong>Dental</strong> 201 Walmart Dr Uniontown PA 15401 General <strong>Provider</strong> Fayette<br />

Monios George 038052 Aspen <strong>Dental</strong> 201 Walmart Dr Uniontown PA 15401 General <strong>Provider</strong> Fayette<br />

Raja Nabila 038052 Aspen <strong>Dental</strong> 201 Walmart Dr Uniontown PA 15401 General <strong>Provider</strong> Fayette<br />

Somers Mitchell 038052 Aspen <strong>Dental</strong> 201 Walmart Dr Uniontown PA 15401 General <strong>Provider</strong> Fayette<br />

Tam Dominic 038052 Aspen <strong>Dental</strong> 201 Walmart Dr Uniontown PA 15401 General <strong>Provider</strong> Fayette<br />

McKee Laura 015255 Community <strong>Dental</strong> <strong>Services</strong> 140 North Beesom Avenue, Suite 400 Uniontown PA 15401 General <strong>Provider</strong> Fayette<br />

McKee Jessica 050956 Cornerstone <strong>Inc</strong> 140 N Beeson Rd, Suite 400 Uniontown PA 15401 General <strong>Provider</strong> Fayette<br />

McKee Laura 050956 Cornerstone <strong>Inc</strong> 140 N Beeson Rd, Suite 400 Uniontown PA 15401 General <strong>Provider</strong> Fayette<br />

Howard-Stickel Brandi 001674 Cornerstone <strong>Inc</strong> 7 Glassworks Rd Greensboro PA 15338 General <strong>Provider</strong> Greene<br />

McKee Jessica 001674 Cornerstone <strong>Inc</strong> 7 Glassworks Rd Greensboro PA 15338 General <strong>Provider</strong> Greene<br />

McKee Laura 001674 Cornerstone <strong>Inc</strong> 7 Glassworks Rd Greensboro PA 15338 General <strong>Provider</strong> Greene<br />

Montgomery R Gregory 001674 Cornerstone <strong>Inc</strong> 7 Glassworks Rd Greensboro PA 15338 General <strong>Provider</strong> Greene<br />

Wilt Rachel 001674 Cornerstone <strong>Inc</strong> 7 Glassworks Rd Greensboro PA 15338 General <strong>Provider</strong> Greene<br />

Lewis Amy 050955 Cornerstone <strong>Inc</strong> Mobile Unit 7 Glassworks Rd. Greensboro PA 15338 General <strong>Provider</strong> Greene<br />

Martin Jarrell 050955 Cornerstone <strong>Inc</strong> Mobile Unit 7 Glassworks Rd. Greensboro PA 15338 General <strong>Provider</strong> Greene<br />

McKee Jessica 050955 Cornerstone <strong>Inc</strong> Mobile Unit 7 Glassworks Rd. Greensboro PA 15338 General <strong>Provider</strong> Greene<br />

McKee Laura 050955 Cornerstone <strong>Inc</strong> Mobile Unit 7 Glassworks Rd. Greensboro PA 15338 General <strong>Provider</strong> Greene<br />

Petrilla Gregory 050924 Primary Health Network/Indiana <strong>Dental</strong> Center 590 Indian Springs Rd Indiana PA 15701 General <strong>Provider</strong> Indiana<br />

Reed John 050924 Primary Health Network/Indiana <strong>Dental</strong> Center 590 Indian Springs Rd Indiana PA 15701 General <strong>Provider</strong> Indiana<br />

Attri Neellam 002096 Aspen <strong>Dental</strong> Associates of NE PA PC 1516 Scranton - Carbondale Hwy Scranton PA 18508 General <strong>Provider</strong> Lackawanna<br />

Babameto Blendi 002096 Aspen <strong>Dental</strong> Associates of NE PA PC 1516 Scranton - Carbondale Hwy Scranton PA 18508 Oral Surgeon Lackawanna<br />

Bannenahally Shruthi 002096 Aspen <strong>Dental</strong> Associates of NE PA PC 1516 Scranton - Carbondale Hwy Scranton PA 18508 General <strong>Provider</strong> Lackawanna<br />

Botros Samuel 002096 Aspen <strong>Dental</strong> Associates of NE PA PC 1516 Scranton - Carbondale Hwy Scranton PA 18508 General <strong>Provider</strong> Lackawanna<br />

Chandalada Agastayya 002096 Aspen <strong>Dental</strong> Associates of NE PA PC 1516 Scranton - Carbondale Hwy Scranton PA 18508 General <strong>Provider</strong> Lackawanna<br />

Chaudhry Ahmad 002096 Aspen <strong>Dental</strong> Associates of NE PA PC 1516 Scranton - Carbondale Hwy Scranton PA 18508 General <strong>Provider</strong> Lackawanna<br />

Gupta Shekhar 002096 Aspen <strong>Dental</strong> Associates of NE PA PC 1516 Scranton - Carbondale Hwy Scranton PA 18508 General <strong>Provider</strong> Lackawanna<br />

Harris Chad 002096 Aspen <strong>Dental</strong> Associates of NE PA PC 1516 Scranton - Carbondale Hwy Scranton PA 18508 General <strong>Provider</strong> Lackawanna<br />

Hu Yu Hui 002096 Aspen <strong>Dental</strong> Associates of NE PA PC 1516 Scranton - Carbondale Hwy Scranton PA 18508 General <strong>Provider</strong> Lackawanna<br />

Kunam Ramya 002096 Aspen <strong>Dental</strong> Associates of NE PA PC 1516 Scranton - Carbondale Hwy Scranton PA 18508 General <strong>Provider</strong> Lackawanna<br />

Patel Udaykumar 002096 Aspen <strong>Dental</strong> Associates of NE PA PC 1516 Scranton - Carbondale Hwy Scranton PA 18508 General <strong>Provider</strong> Lackawanna<br />

Pham Thuy 002096 Aspen <strong>Dental</strong> Associates of NE PA PC 1516 Scranton - Carbondale Hwy Scranton PA 18508 General <strong>Provider</strong> Lackawanna<br />

Prasad Neralagadde 002096 Aspen <strong>Dental</strong> Associates of NE PA PC 1516 Scranton - Carbondale Hwy Scranton PA 18508 General <strong>Provider</strong> Lackawanna<br />

Tran Joshua 002096 Aspen <strong>Dental</strong> Associates of NE PA PC 1516 Scranton - Carbondale Hwy Scranton PA 18508 General <strong>Provider</strong> Lackawanna<br />

Williams Christopher 002096 Aspen <strong>Dental</strong> Associates of NE PA PC 1516 Scranton - Carbondale Hwy Scranton PA 18508 General <strong>Provider</strong> Lackawanna<br />

Withanachchi Janatha 002096 Aspen <strong>Dental</strong> Associates of NE PA PC 1516 Scranton - Carbondale Hwy Scranton PA 18508 Endodontist Lackawanna<br />

Babameto Blendi 033853 Aspen <strong>Dental</strong> Associates NE PA PLLC 1954 Fruitville Pike Lancaster PA 17601 Oral Surgeon Lancaster<br />

Botros Samuel 033853 Aspen <strong>Dental</strong> Associates NE PA PLLC 1954 Fruitville Pike Lancaster PA 17601 General <strong>Provider</strong> Lancaster<br />

Chandalada Agastayya 033853 Aspen <strong>Dental</strong> Associates NE PA PLLC 1954 Fruitville Pike Lancaster PA 17601 General <strong>Provider</strong> Lancaster<br />

Chaudhry Ahmad 033853 Aspen <strong>Dental</strong> Associates NE PA PLLC 1954 Fruitville Pike Lancaster PA 17601 General <strong>Provider</strong> Lancaster<br />

Gupta Shekhar 033853 Aspen <strong>Dental</strong> Associates NE PA PLLC 1954 Fruitville Pike Lancaster PA 17601 General <strong>Provider</strong> Lancaster<br />

Hamati Isam 033853 Aspen <strong>Dental</strong> Associates NE PA PLLC 1954 Fruitville Pike Lancaster PA 17601 General <strong>Provider</strong> Lancaster<br />

Hu Yu Hui 033853 Aspen <strong>Dental</strong> Associates NE PA PLLC 1954 Fruitville Pike Lancaster PA 17601 General <strong>Provider</strong> Lancaster<br />

Kunam Ramya 033853 Aspen <strong>Dental</strong> Associates NE PA PLLC 1954 Fruitville Pike Lancaster PA 17601 General <strong>Provider</strong> Lancaster<br />

Pham Thuy 033853 Aspen <strong>Dental</strong> Associates NE PA PLLC 1954 Fruitville Pike Lancaster PA 17601 General <strong>Provider</strong> Lancaster<br />

Prasad Neralagadde 033853 Aspen <strong>Dental</strong> Associates NE PA PLLC 1954 Fruitville Pike Lancaster PA 17601 General <strong>Provider</strong> Lancaster<br />

Tran Joshua 033853 Aspen <strong>Dental</strong> Associates NE PA PLLC 1954 Fruitville Pike Lancaster PA 17601 General <strong>Provider</strong> Lancaster<br />

Williams Christopher 033853 Aspen <strong>Dental</strong> Associates NE PA PLLC 1954 Fruitville Pike Lancaster PA 17601 General <strong>Provider</strong> Lancaster<br />

Withanachchi Janatha 033853 Aspen <strong>Dental</strong> Associates NE PA PLLC 1954 Fruitville Pike Lancaster PA 17601 Endodontist Lancaster<br />

* Strause Roger 001341 Centerville Family <strong>Dental</strong> 803 Estelle Dr. Lancaster PA 17601 General <strong>Provider</strong> Lancaster<br />

Charkas Ahmad 097846 Allied Orthodontics PC 60 W Walnut St Lancaster PA 17602 Orthodontist Lancaster<br />

* Indicates dentist that is accepting current patients only.<br />

All <strong>Select</strong> <strong>Plan</strong> Dentists Page 26<br />

1 Same as a DHMO with fixed member copayments, no annual maximum dollar limits, no waiting periods, no deductibles, no pre-authorization paperwork or pre-treatment estimates and no<br />

claim forms or proof of loss (except in the case of out-of-area emergencies). Member must enroll with a General Dentist. Fac ID is used to indicate which facility a member chooses.


SELECT PLAN 1 DENTIST DIRECTORY<br />

Dentists listed are under contract as of 10/1/12<br />

Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />

Evans Marianna 097846 Allied Orthodontics PC 60 W Walnut St Lancaster PA 17602 Orthodontist Lancaster<br />

O'Donnell Daniel 001720 O'Donnell & Phillips LLC 230 Harrisburg Ave., Suite 5 Lancaster PA 17603 General <strong>Provider</strong> Lancaster<br />

Phillips Jason 001720 O'Donnell & Phillips LLC 230 Harrisburg Ave., Suite 5 Lancaster PA 17603 General <strong>Provider</strong> Lancaster<br />

Charkas Ahmad 070959 Allied Orthodontics PC 1555 Highlands Dr, Suite 190 Lititz PA 17543 Orthodontist Lancaster<br />

Evans Marianna 070959 Allied Orthodontics PC 1555 Highlands Dr, Suite 190 Lititz PA 17543 Orthodontist Lancaster<br />

Ahmadzadeh Bijan 050977 Lancaster <strong>Dental</strong> Arts PC 1555 Highlands Dr, Suite190 Lititz PA 17543 General <strong>Provider</strong> Lancaster<br />

Desai Kaushal 050977 Lancaster <strong>Dental</strong> Arts PC 1555 Highlands Dr, Suite190 Lititz PA 17543 General <strong>Provider</strong> Lancaster<br />

Kopp Anatoliy 050977 Lancaster <strong>Dental</strong> Arts PC 1555 Highlands Dr, Suite190 Lititz PA 17543 General <strong>Provider</strong> Lancaster<br />

Lam Everest 050977 Lancaster <strong>Dental</strong> Arts PC 1555 Highlands Dr, Suite190 Lititz PA 17543 General <strong>Provider</strong> Lancaster<br />

Moriarty Sean 050977 Lancaster <strong>Dental</strong> Arts PC 1555 Highlands Dr, Suite190 Lititz PA 17543 General <strong>Provider</strong> Lancaster<br />

Savani Bhaskar 050977 Lancaster <strong>Dental</strong> Arts PC 1555 Highlands Dr, Suite190 Lititz PA 17543 General <strong>Provider</strong> Lancaster<br />

Savani Bhumi 050977 Lancaster <strong>Dental</strong> Arts PC 1555 Highlands Dr, Suite190 Lititz PA 17543 General <strong>Provider</strong> Lancaster<br />

Savani Niranjan 050977 Lancaster <strong>Dental</strong> Arts PC 1555 Highlands Dr, Suite190 Lititz PA 17543 General <strong>Provider</strong> Lancaster<br />

Lockawich Douglas 001643 Douglas Lockawich, D.M.D. 603 Crescent Avenue Ellwood City PA 16117 General <strong>Provider</strong> Lawrence<br />

* Paige James 001482 James R. Paige, D.D.S. 802 W. Washington Street New Castle PA 16101 General <strong>Provider</strong> Lawrence<br />

Beal Rhonda 001613 Primary Health Network/New Castle <strong>Dental</strong> Center 2807 Wilmington Rd New Castle PA 16105 General <strong>Provider</strong> Lawrence<br />

Cole Duane 001613 Primary Health Network/New Castle <strong>Dental</strong> Center 2807 Wilmington Rd New Castle PA 16105 General <strong>Provider</strong> Lawrence<br />

Hartle Sheila 001613 Primary Health Network/New Castle <strong>Dental</strong> Center 2807 Wilmington Rd New Castle PA 16105 General <strong>Provider</strong> Lawrence<br />

Petrilla Gregory 001613 Primary Health Network/New Castle <strong>Dental</strong> Center 2807 Wilmington Rd New Castle PA 16105 General <strong>Provider</strong> Lawrence<br />

Reed John 001613 Primary Health Network/New Castle <strong>Dental</strong> Center 2807 Wilmington Rd New Castle PA 16105 General <strong>Provider</strong> Lawrence<br />

Bui Loc 001343 Mimosa Family Dentistry, P.C. 117 W. Cherry St. Palmyra PA 17078 General <strong>Provider</strong> Lebanon<br />

Bui Toan 001343 Mimosa Family Dentistry, P.C. 117 W. Cherry St. Palmyra PA 17078 General <strong>Provider</strong> Lebanon<br />

Bandelac Georges 070950 A+ Periodontic Specialty Care PC 1247 S Cedar Crest Blvd, Suite 300 Allentown PA 18103 Periodontist Lehigh<br />

Evans Marianna 070950 A+ Periodontic Specialty Care PC 1247 S Cedar Crest Blvd, Suite 300 Allentown PA 18103 Periodontist Lehigh<br />

Charkas Ahmad 070958 Allied Orthodontics PC 1247 S Cedar Crest Blvd, Suite 300 Allentown PA 18103 Orthodontist Lehigh<br />

Evans Marianna 070958 Allied Orthodontics PC 1247 S Cedar Crest Blvd, Suite 300 Allentown PA 18103 Orthodontist Lehigh<br />

Bhatnagar Payal 002358 Aspen <strong>Dental</strong> Associates of NY., P.C. 319 South Cedar Creek Blvd. Allentown PA 18103 General <strong>Provider</strong> Lehigh<br />

Chadha Chandan 002358 Aspen <strong>Dental</strong> Associates of NY., P.C. 319 South Cedar Creek Blvd. Allentown PA 18103 General <strong>Provider</strong> Lehigh<br />

Chaudhry Ahmad 002358 Aspen <strong>Dental</strong> Associates of NY., P.C. 319 South Cedar Creek Blvd. Allentown PA 18103 General <strong>Provider</strong> Lehigh<br />

Kim Peter 002358 Aspen <strong>Dental</strong> Associates of NY., P.C. 319 South Cedar Creek Blvd. Allentown PA 18103 General <strong>Provider</strong> Lehigh<br />

Malhotra Swati 002358 Aspen <strong>Dental</strong> Associates of NY., P.C. 319 South Cedar Creek Blvd. Allentown PA 18103 General <strong>Provider</strong> Lehigh<br />

Obaid Michel 002358 Aspen <strong>Dental</strong> Associates of NY., P.C. 319 South Cedar Creek Blvd. Allentown PA 18103 General <strong>Provider</strong> Lehigh<br />

Rajput Bhumika 002358 Aspen <strong>Dental</strong> Associates of NY., P.C. 319 South Cedar Creek Blvd. Allentown PA 18103 General <strong>Provider</strong> Lehigh<br />

Sambaraju Haritha 002358 Aspen <strong>Dental</strong> Associates of NY., P.C. 319 South Cedar Creek Blvd. Allentown PA 18103 General <strong>Provider</strong> Lehigh<br />

Withanachchi Janatha 002358 Aspen <strong>Dental</strong> Associates of NY., P.C. 319 South Cedar Creek Blvd. Allentown PA 18103 Endodontist Lehigh<br />

Yi Tyler 002358 Aspen <strong>Dental</strong> Associates of NY., P.C. 319 South Cedar Creek Blvd. Allentown PA 18103 General <strong>Provider</strong> Lehigh<br />

Agrawal Avanti 051021 Smile Krafters PC 1247 S Cedar Crest Blvd, Suite 300 Allentown PA 18103 General <strong>Provider</strong> Lehigh<br />

Derosa Daniel 051021 Smile Krafters PC 1247 S Cedar Crest Blvd, Suite 300 Allentown PA 18103 General <strong>Provider</strong> Lehigh<br />

Desai Kaushal 051021 Smile Krafters PC 1247 S Cedar Crest Blvd, Suite 300 Allentown PA 18103 General <strong>Provider</strong> Lehigh<br />

Dormeshian Andrew 051021 Smile Krafters PC 1247 S Cedar Crest Blvd, Suite 300 Allentown PA 18103 General <strong>Provider</strong> Lehigh<br />

Gombar Anna 051021 Smile Krafters PC 1247 S Cedar Crest Blvd, Suite 300 Allentown PA 18103 General <strong>Provider</strong> Lehigh<br />

Kopp Anatoliy 051021 Smile Krafters PC 1247 S Cedar Crest Blvd, Suite 300 Allentown PA 18103 General <strong>Provider</strong> Lehigh<br />

Savani Bhaskar 051021 Smile Krafters PC 1247 S Cedar Crest Blvd, Suite 300 Allentown PA 18103 General <strong>Provider</strong> Lehigh<br />

Savani Bhumi 051021 Smile Krafters PC 1247 S Cedar Crest Blvd, Suite 300 Allentown PA 18103 General <strong>Provider</strong> Lehigh<br />

Savani Niranjan 051021 Smile Krafters PC 1247 S Cedar Crest Blvd, Suite 300 Allentown PA 18103 General <strong>Provider</strong> Lehigh<br />

Todd Meredith 051021 Smile Krafters PC 1247 S Cedar Crest Blvd, Suite 300 Allentown PA 18103 General <strong>Provider</strong> Lehigh<br />

Panossian Antoine 081808 A+ Oral Surgery Specialty Care PC 1247 S Cedar Crest Blvd, Suite 300 Allentown PA 18104 Oral Surgeon Lehigh<br />

Tran David 081808 A+ Oral Surgery Specialty Care PC 1247 S Cedar Crest Blvd, Suite 300 Allentown PA 18104 Oral Surgeon Lehigh<br />

Ferguson Michele 000635 Gentle <strong>Dental</strong> Allentown LLC 2015 W Hamilton St., Suite 202 Allentown PA 18104 General <strong>Provider</strong> Lehigh<br />

Halpern Wendy 000635 Gentle <strong>Dental</strong> Allentown LLC 2015 W Hamilton St., Suite 202 Allentown PA 18104 Periodontist Lehigh<br />

Libou Keith 000635 Gentle <strong>Dental</strong> Allentown LLC 2015 W Hamilton St., Suite 202 Allentown PA 18104 General <strong>Provider</strong> Lehigh<br />

Minetola Mark 000635 Gentle <strong>Dental</strong> Allentown LLC 2015 W Hamilton St., Suite 202 Allentown PA 18104 General <strong>Provider</strong> Lehigh<br />

Samineni Neelima 000635 Gentle <strong>Dental</strong> Allentown LLC 2015 W Hamilton St., Suite 202 Allentown PA 18104 General <strong>Provider</strong> Lehigh<br />

Panossian Antoine 070977 A+ Oral Surgery Specialty Care PC 1901 Union Blvd Allentown PA 18109 Oral Surgeon Lehigh<br />

Tran David 070977 A+ Oral Surgery Specialty Care PC 1901 Union Blvd Allentown PA 18109 Oral Surgeon Lehigh<br />

Bhatnagar Payal 038065 Aspen <strong>Dental</strong> 1856 Airport Rd Allentown PA 18109 General <strong>Provider</strong> Lehigh<br />

Chadha Chandan 038065 Aspen <strong>Dental</strong> 1856 Airport Rd Allentown PA 18109 General <strong>Provider</strong> Lehigh<br />

Chaudhry Ahmad 038065 Aspen <strong>Dental</strong> 1856 Airport Rd Allentown PA 18109 General <strong>Provider</strong> Lehigh<br />

Kim Peter 038065 Aspen <strong>Dental</strong> 1856 Airport Rd Allentown PA 18109 General <strong>Provider</strong> Lehigh<br />

Malhotra Swati 038065 Aspen <strong>Dental</strong> 1856 Airport Rd Allentown PA 18109 General <strong>Provider</strong> Lehigh<br />

Obaid Michel 038065 Aspen <strong>Dental</strong> 1856 Airport Rd Allentown PA 18109 General <strong>Provider</strong> Lehigh<br />

Rajput Bhumika 038065 Aspen <strong>Dental</strong> 1856 Airport Rd Allentown PA 18109 General <strong>Provider</strong> Lehigh<br />

Sambaraju Haritha 038065 Aspen <strong>Dental</strong> 1856 Airport Rd Allentown PA 18109 General <strong>Provider</strong> Lehigh<br />

Withanachchi Janatha 038065 Aspen <strong>Dental</strong> 1856 Airport Rd Allentown PA 18109 Endodontist Lehigh<br />

Yi Tyler 038065 Aspen <strong>Dental</strong> 1856 Airport Rd Allentown PA 18109 General <strong>Provider</strong> Lehigh<br />

Attri Neellam 002883 Aspen <strong>Dental</strong> Associates of NEPA, PLLC 741 Airport Rd. Hazle Township PA 18202 General <strong>Provider</strong> Luzerne<br />

* Indicates dentist that is accepting current patients only.<br />

All <strong>Select</strong> <strong>Plan</strong> Dentists Page 27<br />

1 Same as a DHMO with fixed member copayments, no annual maximum dollar limits, no waiting periods, no deductibles, no pre-authorization paperwork or pre-treatment estimates and no<br />

claim forms or proof of loss (except in the case of out-of-area emergencies). Member must enroll with a General Dentist. Fac ID is used to indicate which facility a member chooses.


SELECT PLAN 1 DENTIST DIRECTORY<br />

Dentists listed are under contract as of 10/1/12<br />

Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />

Babameto Blendi 002883 Aspen <strong>Dental</strong> Associates of NEPA, PLLC 741 Airport Rd. Hazle Township PA 18202 Oral Surgeon Luzerne<br />

Bannenahally Shruthi 002883 Aspen <strong>Dental</strong> Associates of NEPA, PLLC 741 Airport Rd. Hazle Township PA 18202 General <strong>Provider</strong> Luzerne<br />

Botros Samuel 002883 Aspen <strong>Dental</strong> Associates of NEPA, PLLC 741 Airport Rd. Hazle Township PA 18202 General <strong>Provider</strong> Luzerne<br />

Chandalada Agastayya 002883 Aspen <strong>Dental</strong> Associates of NEPA, PLLC 741 Airport Rd. Hazle Township PA 18202 General <strong>Provider</strong> Luzerne<br />

Chaudhry Ahmad 002883 Aspen <strong>Dental</strong> Associates of NEPA, PLLC 741 Airport Rd. Hazle Township PA 18202 General <strong>Provider</strong> Luzerne<br />

Gupta Shekhar 002883 Aspen <strong>Dental</strong> Associates of NEPA, PLLC 741 Airport Rd. Hazle Township PA 18202 General <strong>Provider</strong> Luzerne<br />

Harris Chad 002883 Aspen <strong>Dental</strong> Associates of NEPA, PLLC 741 Airport Rd. Hazle Township PA 18202 General <strong>Provider</strong> Luzerne<br />

Hu Yu Hui 002883 Aspen <strong>Dental</strong> Associates of NEPA, PLLC 741 Airport Rd. Hazle Township PA 18202 General <strong>Provider</strong> Luzerne<br />

Kunam Ramya 002883 Aspen <strong>Dental</strong> Associates of NEPA, PLLC 741 Airport Rd. Hazle Township PA 18202 General <strong>Provider</strong> Luzerne<br />

Patel Udaykumar 002883 Aspen <strong>Dental</strong> Associates of NEPA, PLLC 741 Airport Rd. Hazle Township PA 18202 General <strong>Provider</strong> Luzerne<br />

Pham Thuy 002883 Aspen <strong>Dental</strong> Associates of NEPA, PLLC 741 Airport Rd. Hazle Township PA 18202 General <strong>Provider</strong> Luzerne<br />

Prasad Neralagadde 002883 Aspen <strong>Dental</strong> Associates of NEPA, PLLC 741 Airport Rd. Hazle Township PA 18202 General <strong>Provider</strong> Luzerne<br />

Sambaraju Haritha 002883 Aspen <strong>Dental</strong> Associates of NEPA, PLLC 741 Airport Rd. Hazle Township PA 18202 General <strong>Provider</strong> Luzerne<br />

Tran Joshua 002883 Aspen <strong>Dental</strong> Associates of NEPA, PLLC 741 Airport Rd. Hazle Township PA 18202 General <strong>Provider</strong> Luzerne<br />

Withanachchi Janatha 002883 Aspen <strong>Dental</strong> Associates of NEPA, PLLC 741 Airport Rd. Hazle Township PA 18202 Endodontist Luzerne<br />

Albertine Joseph 001722 Joseph Albertine DDS 239 Muir Ave. Hazleton PA 18201 General <strong>Provider</strong> Luzerne<br />

Jacques Denis 001807 Pittston <strong>Dental</strong> Center 34 S. Main St. Pittston PA 18640 General <strong>Provider</strong> Luzerne<br />

Polter Joel 001807 Pittston <strong>Dental</strong> Center 34 S. Main St. Pittston PA 18640 General <strong>Provider</strong> Luzerne<br />

LaFoca Santo 001724 Santo LaFoca, D.M.D. 20 N. Main St. Pittston PA 18640 General <strong>Provider</strong> Luzerne<br />

Smith Eric 001724 Santo LaFoca, D.M.D. 20 N. Main St. Pittston PA 18640 General <strong>Provider</strong> Luzerne<br />

Specter James 000667 Oral Surgery Associates of Wyoming Valley, <strong>Inc</strong>. 34 South Main Street Wilkes Barre PA 18701 Oral Surgeon Luzerne<br />

Zampetti Ralph 000667 Oral Surgery Associates of Wyoming Valley, <strong>Inc</strong>. 34 South Main Street Wilkes Barre PA 18701 Oral Surgeon Luzerne<br />

Babameto Blendi 002240 Aspen <strong>Dental</strong> Associates of NE PA PLLC 2168 Wilkes-Barre Township, Market Place Wilkes Barre PA 18702 Oral Surgeon Luzerne<br />

Botros Samuel 002240 Aspen <strong>Dental</strong> Associates of NE PA PLLC 2168 Wilkes-Barre Township, Market Place Wilkes Barre PA 18702 General <strong>Provider</strong> Luzerne<br />

Chandalada Agastayya 002240 Aspen <strong>Dental</strong> Associates of NE PA PLLC 2168 Wilkes-Barre Township, Market Place Wilkes Barre PA 18702 General <strong>Provider</strong> Luzerne<br />

Hamati Isam 002240 Aspen <strong>Dental</strong> Associates of NE PA PLLC 2168 Wilkes-Barre Township, Market Place Wilkes Barre PA 18702 General <strong>Provider</strong> Luzerne<br />

Hu Yu Hui 002240 Aspen <strong>Dental</strong> Associates of NE PA PLLC 2168 Wilkes-Barre Township, Market Place Wilkes Barre PA 18702 General <strong>Provider</strong> Luzerne<br />

Noel Rubins 002240 Aspen <strong>Dental</strong> Associates of NE PA PLLC 2168 Wilkes-Barre Township, Market Place Wilkes Barre PA 18702 General <strong>Provider</strong> Luzerne<br />

Patel Udaykumar 002240 Aspen <strong>Dental</strong> Associates of NE PA PLLC 2168 Wilkes-Barre Township, Market Place Wilkes Barre PA 18702 General <strong>Provider</strong> Luzerne<br />

Pham Thuy 002240 Aspen <strong>Dental</strong> Associates of NE PA PLLC 2168 Wilkes-Barre Township, Market Place Wilkes Barre PA 18702 General <strong>Provider</strong> Luzerne<br />

Tran Joshua 002240 Aspen <strong>Dental</strong> Associates of NE PA PLLC 2168 Wilkes-Barre Township, Market Place Wilkes Barre PA 18702 General <strong>Provider</strong> Luzerne<br />

Williams Christopher 002240 Aspen <strong>Dental</strong> Associates of NE PA PLLC 2168 Wilkes-Barre Township, Market Place Wilkes Barre PA 18702 General <strong>Provider</strong> Luzerne<br />

Withanachchi Janatha 002240 Aspen <strong>Dental</strong> Associates of NE PA PLLC 2168 Wilkes-Barre Township, Market Place Wilkes Barre PA 18702 Endodontist Luzerne<br />

Walthour William 000483 William Walthour, D.D.S. 213 East Market Street Wilkes Barre PA 18702 General <strong>Provider</strong> Luzerne<br />

Mastrini Louis 000386 Louis J. Mastrini, D.D.S. 672 North River St, Suite 209 Wilkes Barre PA 18705 General <strong>Provider</strong> Luzerne<br />

Babameto Blendi 038097 Aspen <strong>Dental</strong> Associates of NE PA PC 340 S Lycoming Mall Rd, Suite 10 Muncy PA 17756 Oral Surgeon Lycoming<br />

Botros Samuel 038097 Aspen <strong>Dental</strong> Associates of NE PA PC 340 S Lycoming Mall Rd, Suite 10 Muncy PA 17756 General <strong>Provider</strong> Lycoming<br />

Chandalada Agastayya 038097 Aspen <strong>Dental</strong> Associates of NE PA PC 340 S Lycoming Mall Rd, Suite 10 Muncy PA 17756 General <strong>Provider</strong> Lycoming<br />

Ciarallo Robert 038097 Aspen <strong>Dental</strong> Associates of NE PA PC 340 S Lycoming Mall Rd, Suite 10 Muncy PA 17756 Oral Surgeon Lycoming<br />

Harris Chad 038097 Aspen <strong>Dental</strong> Associates of NE PA PC 340 S Lycoming Mall Rd, Suite 10 Muncy PA 17756 General <strong>Provider</strong> Lycoming<br />

Hu Yu Hui 038097 Aspen <strong>Dental</strong> Associates of NE PA PC 340 S Lycoming Mall Rd, Suite 10 Muncy PA 17756 General <strong>Provider</strong> Lycoming<br />

Pham Thuy 038097 Aspen <strong>Dental</strong> Associates of NE PA PC 340 S Lycoming Mall Rd, Suite 10 Muncy PA 17756 General <strong>Provider</strong> Lycoming<br />

Tran Joshua 038097 Aspen <strong>Dental</strong> Associates of NE PA PC 340 S Lycoming Mall Rd, Suite 10 Muncy PA 17756 General <strong>Provider</strong> Lycoming<br />

Williams Christopher 038097 Aspen <strong>Dental</strong> Associates of NE PA PC 340 S Lycoming Mall Rd, Suite 10 Muncy PA 17756 General <strong>Provider</strong> Lycoming<br />

Withanachchi Janatha 038097 Aspen <strong>Dental</strong> Associates of NE PA PC 340 S Lycoming Mall Rd, Suite 10 Muncy PA 17756 Endodontist Lycoming<br />

Cosgrove William 001611 Primary Health Network/Farrell <strong>Dental</strong> Center 350 Sharon-New Castle Road Farrell PA 16121 General <strong>Provider</strong> Mercer<br />

Jeffries Christian 001611 Primary Health Network/Farrell <strong>Dental</strong> Center 350 Sharon-New Castle Road Farrell PA 16121 General <strong>Provider</strong> Mercer<br />

Reed John 001611 Primary Health Network/Farrell <strong>Dental</strong> Center 350 Sharon-New Castle Road Farrell PA 16121 General <strong>Provider</strong> Mercer<br />

Richards H. Lawrence 001611 Primary Health Network/Farrell <strong>Dental</strong> Center 350 Sharon-New Castle Road Farrell PA 16121 General <strong>Provider</strong> Mercer<br />

Conquest Matthew 050986 Snyder and Dugan Oral Maxillofacial Surgery 2 Greenville Orthopedic Center Greenville PA 16125 Oral Surgeon Mercer<br />

Dugan Michael 050986 Snyder and Dugan Oral Maxillofacial Surgery 2 Greenville Orthopedic Center Greenville PA 16125 Oral Surgeon Mercer<br />

Snyder Richard 050986 Snyder and Dugan Oral Maxillofacial Surgery 2 Greenville Orthopedic Center Greenville PA 16125 Oral Surgeon Mercer<br />

Sweeney Patrick 050986 Snyder and Dugan Oral Maxillofacial Surgery 2 Greenville Orthopedic Center Greenville PA 16125 Oral Surgeon Mercer<br />

Kampas Ronald 080782 Kampas Orthodontics PC 133 S Broad St Grove City PA 16127 Orthodontist Mercer<br />

Cernansky Jaime 037714 Snyder and Dugar Oral and Maxillofacial Surgery 112 S. Broad St Grove City PA 16127 Oral Surgeon Mercer<br />

Conquest Matthew 037714 Snyder and Dugar Oral and Maxillofacial Surgery 112 S. Broad St Grove City PA 16127 Oral Surgeon Mercer<br />

Dugan Michael 037714 Snyder and Dugar Oral and Maxillofacial Surgery 112 S. Broad St Grove City PA 16127 Oral Surgeon Mercer<br />

Snyder Richard 037714 Snyder and Dugar Oral and Maxillofacial Surgery 112 S. Broad St Grove City PA 16127 Oral Surgeon Mercer<br />

Sweeney Patrick 037714 Snyder and Dugar Oral and Maxillofacial Surgery 112 S. Broad St Grove City PA 16127 Oral Surgeon Mercer<br />

Aboosi Omar 002882 Aspen <strong>Dental</strong> Associates of Western PA PC 1049 N. Hermitage Rd. Hermitage PA 16148 General <strong>Provider</strong> Mercer<br />

Bajaj Smriti 002882 Aspen <strong>Dental</strong> Associates of Western PA PC 1049 N. Hermitage Rd. Hermitage PA 16148 General <strong>Provider</strong> Mercer<br />

Barber Timothy 002882 Aspen <strong>Dental</strong> Associates of Western PA PC 1049 N. Hermitage Rd. Hermitage PA 16148 General <strong>Provider</strong> Mercer<br />

Bonczek Brian 002882 Aspen <strong>Dental</strong> Associates of Western PA PC 1049 N. Hermitage Rd. Hermitage PA 16148 General <strong>Provider</strong> Mercer<br />

Budhiraj Anisha 002882 Aspen <strong>Dental</strong> Associates of Western PA PC 1049 N. Hermitage Rd. Hermitage PA 16148 General <strong>Provider</strong> Mercer<br />

Ciarallo Robert 002882 Aspen <strong>Dental</strong> Associates of Western PA PC 1049 N. Hermitage Rd. Hermitage PA 16148 Oral Surgeon Mercer<br />

Fnu Snigdha 002882 Aspen <strong>Dental</strong> Associates of Western PA PC 1049 N. Hermitage Rd. Hermitage PA 16148 General <strong>Provider</strong> Mercer<br />

* Indicates dentist that is accepting current patients only.<br />

All <strong>Select</strong> <strong>Plan</strong> Dentists Page 28<br />

1 Same as a DHMO with fixed member copayments, no annual maximum dollar limits, no waiting periods, no deductibles, no pre-authorization paperwork or pre-treatment estimates and no<br />

claim forms or proof of loss (except in the case of out-of-area emergencies). Member must enroll with a General Dentist. Fac ID is used to indicate which facility a member chooses.


SELECT PLAN 1 DENTIST DIRECTORY<br />

Dentists listed are under contract as of 10/1/12<br />

Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />

Ginde Mayura 002882 Aspen <strong>Dental</strong> Associates of Western PA PC 1049 N. Hermitage Rd. Hermitage PA 16148 General <strong>Provider</strong> Mercer<br />

Grinberg Anna 002882 Aspen <strong>Dental</strong> Associates of Western PA PC 1049 N. Hermitage Rd. Hermitage PA 16148 General <strong>Provider</strong> Mercer<br />

Khalil Mirette 002882 Aspen <strong>Dental</strong> Associates of Western PA PC 1049 N. Hermitage Rd. Hermitage PA 16148 General <strong>Provider</strong> Mercer<br />

Liska Emily 002882 Aspen <strong>Dental</strong> Associates of Western PA PC 1049 N. Hermitage Rd. Hermitage PA 16148 General <strong>Provider</strong> Mercer<br />

Masown Surinder 002882 Aspen <strong>Dental</strong> Associates of Western PA PC 1049 N. Hermitage Rd. Hermitage PA 16148 General <strong>Provider</strong> Mercer<br />

Noel Rubins 002882 Aspen <strong>Dental</strong> Associates of Western PA PC 1049 N. Hermitage Rd. Hermitage PA 16148 General <strong>Provider</strong> Mercer<br />

Poleski Kenneth 002882 Aspen <strong>Dental</strong> Associates of Western PA PC 1049 N. Hermitage Rd. Hermitage PA 16148 General <strong>Provider</strong> Mercer<br />

Ruprecht Heather 002882 Aspen <strong>Dental</strong> Associates of Western PA PC 1049 N. Hermitage Rd. Hermitage PA 16148 General <strong>Provider</strong> Mercer<br />

Saba Christopher 002882 Aspen <strong>Dental</strong> Associates of Western PA PC 1049 N. Hermitage Rd. Hermitage PA 16148 General <strong>Provider</strong> Mercer<br />

Smith Christine 002882 Aspen <strong>Dental</strong> Associates of Western PA PC 1049 N. Hermitage Rd. Hermitage PA 16148 General <strong>Provider</strong> Mercer<br />

Wood Justin 002882 Aspen <strong>Dental</strong> Associates of Western PA PC 1049 N. Hermitage Rd. Hermitage PA 16148 General <strong>Provider</strong> Mercer<br />

Pitts LaTonya 002159 LaTonya E Pitts DDS 40 Chestnut Street Lewistown PA 17044 General <strong>Provider</strong> Mifflin<br />

Babameto Blendi 002671 Aspen <strong>Dental</strong> Associates of NE PA PC 1112 A North Ninth Street Stroudsburg PA 18360 Oral Surgeon Monroe<br />

Botros Samuel 002671 Aspen <strong>Dental</strong> Associates of NE PA PC 1112 A North Ninth Street Stroudsburg PA 18360 General <strong>Provider</strong> Monroe<br />

Chandalada Agastayya 002671 Aspen <strong>Dental</strong> Associates of NE PA PC 1112 A North Ninth Street Stroudsburg PA 18360 General <strong>Provider</strong> Monroe<br />

Gupta Shekhar 002671 Aspen <strong>Dental</strong> Associates of NE PA PC 1112 A North Ninth Street Stroudsburg PA 18360 General <strong>Provider</strong> Monroe<br />

Hu Yu Hui 002671 Aspen <strong>Dental</strong> Associates of NE PA PC 1112 A North Ninth Street Stroudsburg PA 18360 General <strong>Provider</strong> Monroe<br />

Noel Rubins 002671 Aspen <strong>Dental</strong> Associates of NE PA PC 1112 A North Ninth Street Stroudsburg PA 18360 General <strong>Provider</strong> Monroe<br />

Pham Thuy 002671 Aspen <strong>Dental</strong> Associates of NE PA PC 1112 A North Ninth Street Stroudsburg PA 18360 General <strong>Provider</strong> Monroe<br />

Tran Joshua 002671 Aspen <strong>Dental</strong> Associates of NE PA PC 1112 A North Ninth Street Stroudsburg PA 18360 General <strong>Provider</strong> Monroe<br />

Williams Christopher 002671 Aspen <strong>Dental</strong> Associates of NE PA PC 1112 A North Ninth Street Stroudsburg PA 18360 General <strong>Provider</strong> Monroe<br />

Withanachchi Janatha 002671 Aspen <strong>Dental</strong> Associates of NE PA PC 1112 A North Ninth Street Stroudsburg PA 18360 Endodontist Monroe<br />

Dudhat Dilip 002810 Abington <strong>Dental</strong> Excellence 1130 Old York Rd Abington PA 19001 General <strong>Provider</strong> Montgomery<br />

Griffith Robert 000653 Abington Oral and Maxillofacial Surgery, P.C. 1235 Old York Road, Ste 122, Levy Medical Plaza Abington PA 19001 Oral Surgeon Montgomery<br />

Ireland Charles 050921 Dr Charles S Ireland III PC 2400 Pershing Ave Abington PA 19001 General <strong>Provider</strong> Montgomery<br />

Cichetti Michael 070995 Cichetti & DelliGatti Orthodontics PC 7 E Skippack Pike, Suite 105 Ambler PA 19002 Orthodontist Montgomery<br />

DelliGatti Steve 070995 Cichetti & DelliGatti Orthodontics PC 7 E Skippack Pike, Suite 105 Ambler PA 19002 Orthodontist Montgomery<br />

Milewski Michael 070995 Cichetti & DelliGatti Orthodontics PC 7 E Skippack Pike, Suite 105 Ambler PA 19002 Orthodontist Montgomery<br />

Orozco Jacob 070995 Cichetti & DelliGatti Orthodontics PC 7 E Skippack Pike, Suite 105 Ambler PA 19002 Orthodontist Montgomery<br />

Bahn Paul 070986 Pediatric <strong>Dental</strong> Associates 7 E Skippack Pike Ambler PA 19002 Pedodontist Montgomery<br />

D'Agostino Alegra 070986 Pediatric <strong>Dental</strong> Associates 7 E Skippack Pike Ambler PA 19002 Pedodontist Montgomery<br />

Hamilton Sharon 070986 Pediatric <strong>Dental</strong> Associates 7 E Skippack Pike Ambler PA 19002 Pedodontist Montgomery<br />

Kay Lewis 070986 Pediatric <strong>Dental</strong> Associates 7 E Skippack Pike Ambler PA 19002 Pedodontist Montgomery<br />

Quinn Noah 070986 Pediatric <strong>Dental</strong> Associates 7 E Skippack Pike Ambler PA 19002 Pedodontist Montgomery<br />

Rosenbaum Michael 070986 Pediatric <strong>Dental</strong> Associates 7 E Skippack Pike Ambler PA 19002 Pedodontist Montgomery<br />

Thomas Kimberly 070986 Pediatric <strong>Dental</strong> Associates 7 E Skippack Pike Ambler PA 19002 Pedodontist Montgomery<br />

Panossian Antoine 070976 A+ Oral Surgery Specialty Care PC 301 City Line Ave, Suite G 5 Bala Cynwyd PA 19004 Oral Surgeon Montgomery<br />

Tran David 070976 A+ Oral Surgery Specialty Care PC 301 City Line Ave, Suite G 5 Bala Cynwyd PA 19004 Oral Surgeon Montgomery<br />

Charkas Ahmad 070954 Allied Orthodontics PC 301 City Line Ave, Suite G 5 Bala Cynwyd PA 19004 Orthodontist Montgomery<br />

Evans Marianna 070954 Allied Orthodontics PC 301 City Line Ave, Suite G 5 Bala Cynwyd PA 19004 Orthodontist Montgomery<br />

Adams Michael 002796 American <strong>Dental</strong> Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 General <strong>Provider</strong> Montgomery<br />

Bruno Frank 002796 American <strong>Dental</strong> Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 Endodontist Montgomery<br />

Chen Yang 002796 American <strong>Dental</strong> Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 General <strong>Provider</strong> Montgomery<br />

Cohen Hal 002796 American <strong>Dental</strong> Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 General <strong>Provider</strong> Montgomery<br />

Daly Gerald 002796 American <strong>Dental</strong> Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 General <strong>Provider</strong> Montgomery<br />

David Dan 002796 American <strong>Dental</strong> Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 General <strong>Provider</strong> Montgomery<br />

Edmonds R Blake 002796 American <strong>Dental</strong> Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 General <strong>Provider</strong> Montgomery<br />

Elkhatib Mohammad 002796 American <strong>Dental</strong> Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 General <strong>Provider</strong> Montgomery<br />

Fluhr Howard 002796 American <strong>Dental</strong> Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 General <strong>Provider</strong> Montgomery<br />

Gelbart Steven 002796 American <strong>Dental</strong> Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 General <strong>Provider</strong> Montgomery<br />

Kim Jae Woo 002796 American <strong>Dental</strong> Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 General <strong>Provider</strong> Montgomery<br />

Kim Steven 002796 American <strong>Dental</strong> Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 Periodontist Montgomery<br />

Koff Howard 002796 American <strong>Dental</strong> Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 Orthodontist Montgomery<br />

Levy Jamie 002796 American <strong>Dental</strong> Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 Oral Surgeon Montgomery<br />

Li Fuming 002796 American <strong>Dental</strong> Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 General <strong>Provider</strong> Montgomery<br />

Lu John 002796 American <strong>Dental</strong> Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 Periodontist Montgomery<br />

Mojahed Amir 002796 American <strong>Dental</strong> Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 General <strong>Provider</strong> Montgomery<br />

Mumtaz Samera 002796 American <strong>Dental</strong> Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 General <strong>Provider</strong> Montgomery<br />

Nguyen Diep 002796 American <strong>Dental</strong> Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 General <strong>Provider</strong> Montgomery<br />

Oh Jinsuk 002796 American <strong>Dental</strong> Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 General <strong>Provider</strong> Montgomery<br />

Pereia Christine 002796 American <strong>Dental</strong> Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 General <strong>Provider</strong> Montgomery<br />

Roth Michael 002796 American <strong>Dental</strong> Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 Orthodontist Montgomery<br />

Ruggieri John 002796 American <strong>Dental</strong> Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 General <strong>Provider</strong> Montgomery<br />

Sacks Frederick 002796 American <strong>Dental</strong> Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 Oral Surgeon Montgomery<br />

Sandhu Satinder 002796 American <strong>Dental</strong> Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 General <strong>Provider</strong> Montgomery<br />

Sanfacon Dennis 002796 American <strong>Dental</strong> Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 General <strong>Provider</strong> Montgomery<br />

* Indicates dentist that is accepting current patients only.<br />

All <strong>Select</strong> <strong>Plan</strong> Dentists Page 29<br />

1 Same as a DHMO with fixed member copayments, no annual maximum dollar limits, no waiting periods, no deductibles, no pre-authorization paperwork or pre-treatment estimates and no<br />

claim forms or proof of loss (except in the case of out-of-area emergencies). Member must enroll with a General Dentist. Fac ID is used to indicate which facility a member chooses.


SELECT PLAN 1 DENTIST DIRECTORY<br />

Dentists listed are under contract as of 10/1/12<br />

Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />

Shah Nishit 002796 American <strong>Dental</strong> Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 General <strong>Provider</strong> Montgomery<br />

Sultana Parveen 002796 American <strong>Dental</strong> Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 General <strong>Provider</strong> Montgomery<br />

Thilak Preetha 002796 American <strong>Dental</strong> Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 General <strong>Provider</strong> Montgomery<br />

Weinstein Steven 002796 American <strong>Dental</strong> Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 General <strong>Provider</strong> Montgomery<br />

Yang Qing 002796 American <strong>Dental</strong> Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 General <strong>Provider</strong> Montgomery<br />

Yao Zheng 002796 American <strong>Dental</strong> Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 General <strong>Provider</strong> Montgomery<br />

Yoon Simon 002796 American <strong>Dental</strong> Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 General <strong>Provider</strong> Montgomery<br />

Agrawal Avanti 002357 American Family <strong>Dental</strong> Care PC 301 City Line, Suite G-5 Bala Cynwyd PA 19004 General <strong>Provider</strong> Montgomery<br />

Ahmadzadeh Bijan 002357 American Family <strong>Dental</strong> Care PC 301 City Line, Suite G-5 Bala Cynwyd PA 19004 General <strong>Provider</strong> Montgomery<br />

Dapkute Ingrida 002357 American Family <strong>Dental</strong> Care PC 301 City Line, Suite G-5 Bala Cynwyd PA 19004 General <strong>Provider</strong> Montgomery<br />

Derosa Daniel 002357 American Family <strong>Dental</strong> Care PC 301 City Line, Suite G-5 Bala Cynwyd PA 19004 General <strong>Provider</strong> Montgomery<br />

Desai Kaushal 002357 American Family <strong>Dental</strong> Care PC 301 City Line, Suite G-5 Bala Cynwyd PA 19004 General <strong>Provider</strong> Montgomery<br />

Dhyllon Amen 002357 American Family <strong>Dental</strong> Care PC 301 City Line, Suite G-5 Bala Cynwyd PA 19004 General <strong>Provider</strong> Montgomery<br />

Gombar Anna 002357 American Family <strong>Dental</strong> Care PC 301 City Line, Suite G-5 Bala Cynwyd PA 19004 General <strong>Provider</strong> Montgomery<br />

Kim Sunghun 002357 American Family <strong>Dental</strong> Care PC 301 City Line, Suite G-5 Bala Cynwyd PA 19004 General <strong>Provider</strong> Montgomery<br />

Kopp Anatoliy 002357 American Family <strong>Dental</strong> Care PC 301 City Line, Suite G-5 Bala Cynwyd PA 19004 General <strong>Provider</strong> Montgomery<br />

Li Wei 002357 American Family <strong>Dental</strong> Care PC 301 City Line, Suite G-5 Bala Cynwyd PA 19004 General <strong>Provider</strong> Montgomery<br />

Merin Jared 002357 American Family <strong>Dental</strong> Care PC 301 City Line, Suite G-5 Bala Cynwyd PA 19004 General <strong>Provider</strong> Montgomery<br />

Miller Andrew 002357 American Family <strong>Dental</strong> Care PC 301 City Line, Suite G-5 Bala Cynwyd PA 19004 General <strong>Provider</strong> Montgomery<br />

Mitelman Alexandra 002357 American Family <strong>Dental</strong> Care PC 301 City Line, Suite G-5 Bala Cynwyd PA 19004 General <strong>Provider</strong> Montgomery<br />

Moriarty Sean 002357 American Family <strong>Dental</strong> Care PC 301 City Line, Suite G-5 Bala Cynwyd PA 19004 General <strong>Provider</strong> Montgomery<br />

Savani Bhaskar 002357 American Family <strong>Dental</strong> Care PC 301 City Line, Suite G-5 Bala Cynwyd PA 19004 General <strong>Provider</strong> Montgomery<br />

Savani Bhumi 002357 American Family <strong>Dental</strong> Care PC 301 City Line, Suite G-5 Bala Cynwyd PA 19004 General <strong>Provider</strong> Montgomery<br />

Savani Niranjan 002357 American Family <strong>Dental</strong> Care PC 301 City Line, Suite G-5 Bala Cynwyd PA 19004 General <strong>Provider</strong> Montgomery<br />

Sitkovetsky Mikhail 002357 American Family <strong>Dental</strong> Care PC 301 City Line, Suite G-5 Bala Cynwyd PA 19004 General <strong>Provider</strong> Montgomery<br />

Todd Meredith 002357 American Family <strong>Dental</strong> Care PC 301 City Line, Suite G-5 Bala Cynwyd PA 19004 General <strong>Provider</strong> Montgomery<br />

Yanez Rafael 002357 American Family <strong>Dental</strong> Care PC 301 City Line, Suite G-5 Bala Cynwyd PA 19004 General <strong>Provider</strong> Montgomery<br />

Hodges Kellyn 050525 Dr Kellyn Hodges DMD 1 Belmont Ave, Suite 414 Bala Cynwyd PA 19004 Orthodontist Montgomery<br />

Kituskie Leo 002422 Leo J. Kituskie, D.M.D., PC 794 Penlly-Blue Bell Pike Blue Bell PA 19422 Periodontist Montgomery<br />

Dudhat Dilip 002811 Dilip N Dudhat DMD PC 2406 North Broad Street Colmar PA 18915 General <strong>Provider</strong> Montgomery<br />

Yankosky Dennis 000531 Dennis E. Yankosky, D.D.S., PC 2009 Butler Pike Conshohocken PA 19428 General <strong>Provider</strong> Montgomery<br />

Bresler David 001197 David A Bresler DDS PC 1650 Linekiln Pike Dresher PA 19025 Pedodontist Montgomery<br />

Bresler Jason 001197 David A Bresler DDS PC 1650 Linekiln Pike Dresher PA 19025 Pedodontist Montgomery<br />

Bresler Joshua 001197 David A Bresler DDS PC 1650 Linekiln Pike Dresher PA 19025 Pedodontist Montgomery<br />

Mayzenberg Julia 001197 David A Bresler DDS PC 1650 Linekiln Pike Dresher PA 19025 Pedodontist Montgomery<br />

Cherian Mathew 051006 Advanced Family <strong>Dental</strong> Care PC 327 Township Line Rd Elkins Park PA 19027 General <strong>Provider</strong> Montgomery<br />

Adibe Elochukwu 051030 Advanced Family <strong>Dental</strong> Care PC Specialists 327 Township Line Rd Elkins Park PA 19027 Prosthodontist Montgomery<br />

Fratamico Claude 070928 Dr C Fratamico 7608 New Second St Elkins Park PA 19027 General <strong>Provider</strong> Montgomery<br />

Funt Mark 000657 Mark J. Funt, D.M.D., P.C. 401 Township Road, Suite C Elkins Park PA 19027 Oral Surgeon Montgomery<br />

Mehta Taral 070452 Taral T Mehta DMD 1811 Bethlehem Pike, Suite A102 Flourtown PA 19031 General <strong>Provider</strong> Montgomery<br />

Tran David 081881 A + Oral Surgery Specialty Care PC 260 New York Dr, Ste 104 Fort Washington PA 19034 Oral Surgeon Montgomery<br />

Sayles Erik 002819 Drs Schwartz & Schelkun Associates 467 Pennsylvania Ave., Suite 106 Fort Washington PA 19034 Oral Surgeon Montgomery<br />

Schelkun Paul 002819 Drs Schwartz & Schelkun Associates 467 Pennsylvania Ave., Suite 106 Fort Washington PA 19034 Oral Surgeon Montgomery<br />

Mele Mark 000773 Mark J. Mele, D.M.D. 2826 Mt. Carmel Ave., Suite C1 Glenside PA 19038 Orthodontist Montgomery<br />

Tran David 085295 A + Oral Surgery Specialty Care PC 456 School Ln, Ste 102 Harleysville PA 19438 Oral Surgeon Montgomery<br />

Agrawal Avanti 002353 A+ Family <strong>Dental</strong> Care PC 456 School Lane, Suite 104 Harleysville PA 19438 General <strong>Provider</strong> Montgomery<br />

Ahmadzadeh Bijan 002353 A+ Family <strong>Dental</strong> Care PC 456 School Lane, Suite 104 Harleysville PA 19438 General <strong>Provider</strong> Montgomery<br />

Dapkute Ingrida 002353 A+ Family <strong>Dental</strong> Care PC 456 School Lane, Suite 104 Harleysville PA 19438 General <strong>Provider</strong> Montgomery<br />

Derosa Daniel 002353 A+ Family <strong>Dental</strong> Care PC 456 School Lane, Suite 104 Harleysville PA 19438 General <strong>Provider</strong> Montgomery<br />

Desai Kaushal 002353 A+ Family <strong>Dental</strong> Care PC 456 School Lane, Suite 104 Harleysville PA 19438 General <strong>Provider</strong> Montgomery<br />

Gombar Anna 002353 A+ Family <strong>Dental</strong> Care PC 456 School Lane, Suite 104 Harleysville PA 19438 General <strong>Provider</strong> Montgomery<br />

Graziano Janele 002353 A+ Family <strong>Dental</strong> Care PC 456 School Lane, Suite 104 Harleysville PA 19438 General <strong>Provider</strong> Montgomery<br />

Kopp Anatoliy 002353 A+ Family <strong>Dental</strong> Care PC 456 School Lane, Suite 104 Harleysville PA 19438 General <strong>Provider</strong> Montgomery<br />

Lim Mee Kyung 002353 A+ Family <strong>Dental</strong> Care PC 456 School Lane, Suite 104 Harleysville PA 19438 General <strong>Provider</strong> Montgomery<br />

Merin Jared 002353 A+ Family <strong>Dental</strong> Care PC 456 School Lane, Suite 104 Harleysville PA 19438 General <strong>Provider</strong> Montgomery<br />

Mitelman Alexandra 002353 A+ Family <strong>Dental</strong> Care PC 456 School Lane, Suite 104 Harleysville PA 19438 General <strong>Provider</strong> Montgomery<br />

Moriarty Sean 002353 A+ Family <strong>Dental</strong> Care PC 456 School Lane, Suite 104 Harleysville PA 19438 General <strong>Provider</strong> Montgomery<br />

Nguyen Vu 002353 A+ Family <strong>Dental</strong> Care PC 456 School Lane, Suite 104 Harleysville PA 19438 General <strong>Provider</strong> Montgomery<br />

Savani Bhaskar 002353 A+ Family <strong>Dental</strong> Care PC 456 School Lane, Suite 104 Harleysville PA 19438 General <strong>Provider</strong> Montgomery<br />

Savani Bhumi 002353 A+ Family <strong>Dental</strong> Care PC 456 School Lane, Suite 104 Harleysville PA 19438 General <strong>Provider</strong> Montgomery<br />

Savani Niranjan 002353 A+ Family <strong>Dental</strong> Care PC 456 School Lane, Suite 104 Harleysville PA 19438 General <strong>Provider</strong> Montgomery<br />

Todd Meredith 002353 A+ Family <strong>Dental</strong> Care PC 456 School Lane, Suite 104 Harleysville PA 19438 General <strong>Provider</strong> Montgomery<br />

Bandelac Georges 070947 A+ Periodontic Specialty Care PC 456 School Ln, Suite 104 Harleysville PA 19438 Periodontist Montgomery<br />

Evans Marianna 070947 A+ Periodontic Specialty Care PC 456 School Ln, Suite 104 Harleysville PA 19438 Periodontist Montgomery<br />

Charkas Ahmad 070955 Allied Orthodontics PC 456 School Ln, Suite 101 Harleysville PA 19438 Orthodontist Montgomery<br />

Evans Marianna 070955 Allied Orthodontics PC 456 School Ln, Suite 101 Harleysville PA 19438 Orthodontist Montgomery<br />

* Indicates dentist that is accepting current patients only.<br />

All <strong>Select</strong> <strong>Plan</strong> Dentists Page 30<br />

1 Same as a DHMO with fixed member copayments, no annual maximum dollar limits, no waiting periods, no deductibles, no pre-authorization paperwork or pre-treatment estimates and no<br />

claim forms or proof of loss (except in the case of out-of-area emergencies). Member must enroll with a General Dentist. Fac ID is used to indicate which facility a member chooses.


SELECT PLAN 1 DENTIST DIRECTORY<br />

Dentists listed are under contract as of 10/1/12<br />

Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />

Dudhat Dilip 051036 Advanced <strong>Dental</strong> <strong>Services</strong> PC 533 N York Rd Hatboro PA 19040 General <strong>Provider</strong> Montgomery<br />

Gevirtz David 000920 Horsham <strong>Dental</strong> Associates 623-A Horsham Road Horsham PA 19044 General <strong>Provider</strong> Montgomery<br />

Bresler David 025055 David A Bresler DDS PC 101 Old York Road, One Abington Plaza Suite 301 Jenkintown PA 19046 Pedodontist Montgomery<br />

Bresler Jason 025055 David A Bresler DDS PC 101 Old York Road, One Abington Plaza Suite 301 Jenkintown PA 19046 Pedodontist Montgomery<br />

Bresler Joshua 025055 David A Bresler DDS PC 101 Old York Road, One Abington Plaza Suite 301 Jenkintown PA 19046 Pedodontist Montgomery<br />

Mayzenberg Julia 025055 David A Bresler DDS PC 101 Old York Road, One Abington Plaza Suite 301 Jenkintown PA 19046 Pedodontist Montgomery<br />

Schoengold Irwin 001098 I.N. Schoengold, D.M.D. & S.J. Ziccinolfi, D.M.D. The Pavilion - Suite 323, 261 Old York Road Jenkintown PA 19046 Endodontist Montgomery<br />

Zicchnolfi Steven 001098 I.N. Schoengold, D.M.D. & S.J. Ziccinolfi, D.M.D. The Pavilion - Suite 323, 261 Old York Road Jenkintown PA 19046 Endodontist Montgomery<br />

Evian Cyril 000736 Cyril I Evian, D.M.D. 10112 Valley Forge Circle, Suite 112 King Of Prussia PA 19406 Periodontist Montgomery<br />

Wohar Robert 000733 Robert M. Wohar, D.M.D. 357 Gulph Rd, 200 King Of Prussia PA 19406 Oral Surgeon Montgomery<br />

* Javier Bonifacio 000391 Sumney Forge Family Dentistry 850 S. Valley Forge Rd. Lansdale PA 19446 General <strong>Provider</strong> Montgomery<br />

Iskender Azad 050876 Confident Smile <strong>Dental</strong> 3 West Ridge Pike Limerick PA 19468 General <strong>Provider</strong> Montgomery<br />

Hodges Kellyn 050527 Dr Kellyn Hodges DMD 411 Doylestown Rd Montgomeryville PA 18936 Orthodontist Montgomery<br />

Habboush Sarmad 069566 Essex <strong>Dental</strong> 106 N Essex Ave, Suite C Narberth PA 19072 General <strong>Provider</strong> Montgomery<br />

Reddy Konreddy 001928 A-One <strong>Dental</strong> Care 11 West LaFayette St. Norristown PA 19401 General <strong>Provider</strong> Montgomery<br />

Rothman Marc 000713 Bernard N. Rothman, D.D.S., P.A. 1325 West Airy Street Norristown PA 19401 Oral Surgeon Montgomery<br />

Hockman Donald 000509 Donald F. Hockman, D.D.S. 323 W Johnson Hwy Norristown PA 19401 General <strong>Provider</strong> Montgomery<br />

Carp Brian 000501 Moses & Carp <strong>Dental</strong> Associates 610 W. Marshall St. Norristown PA 19401 General <strong>Provider</strong> Montgomery<br />

Yu Paul 000501 Moses & Carp <strong>Dental</strong> Associates 610 W. Marshall St. Norristown PA 19401 General <strong>Provider</strong> Montgomery<br />

Levito, Jr Vincent 061258 Vincent J Levito Jr DMD PC Family & Cosmetic Denti 1733 Markley St Norristown PA 19401 General <strong>Provider</strong> Montgomery<br />

Elbardissi Angel 000835 Angel W. Elbardissi, D.D.S. 210 Stump Road North Wales PA 19454 General <strong>Provider</strong> Montgomery<br />

Kim Tae-Soo 072104 Apple Family Dentist 275 Deklab Pike North Wales PA 19454 General <strong>Provider</strong> Montgomery<br />

Charkas Ahmad 070962 Allied Orthodontics PC 450 Cresson Blvd, Suite 120 Oaks PA 19456 Orthodontist Montgomery<br />

Evans Marianna 070962 Allied Orthodontics PC 450 Cresson Blvd, Suite 120 Oaks PA 19456 Orthodontist Montgomery<br />

Desai Kaushal 070932 American Family <strong>Dental</strong> Care 450 Cresson Blvd, Suite 210 Oaks PA 19456 General <strong>Provider</strong> Montgomery<br />

Kopp Anatoliy 070932 American Family <strong>Dental</strong> Care 450 Cresson Blvd, Suite 210 Oaks PA 19456 General <strong>Provider</strong> Montgomery<br />

Savani Bhaskar 070932 American Family <strong>Dental</strong> Care 450 Cresson Blvd, Suite 210 Oaks PA 19456 General <strong>Provider</strong> Montgomery<br />

Savani Bhumi 070932 American Family <strong>Dental</strong> Care 450 Cresson Blvd, Suite 210 Oaks PA 19456 General <strong>Provider</strong> Montgomery<br />

Yoon Jaewon 070932 American Family <strong>Dental</strong> Care 450 Cresson Blvd, Suite 210 Oaks PA 19456 General <strong>Provider</strong> Montgomery<br />

Abbott Allyson 002020 Allyson A. Abbott, D.M.D. 2050 Butler Pike, Suite 300 Plymouth Meeting PA 19462 Endodontist Montgomery<br />

Kachur Elena 050885 Plymouth Greene <strong>Dental</strong> Associates 1000 Germantown Pike, Suite F4 Plymouth Meeting PA 19462 General <strong>Provider</strong> Montgomery<br />

Plotkin Richard 001038 Richard J. Plotkin, D.M.D. 531 W. Germantown Pike, Suite 204 Plymouth Meeting PA 19462 Oral Surgeon Montgomery<br />

Zhang Ning 037693 All Smile <strong>Dental</strong> Care 393 N Lewis Rd Royersford PA 19468 General <strong>Provider</strong> Montgomery<br />

Agrawal Avanti 050385 A+ Family <strong>Dental</strong> Care PC 744 Route 113 N Souderton PA 18964 General <strong>Provider</strong> Montgomery<br />

Ahmadzadeh Bijan 050385 A+ Family <strong>Dental</strong> Care PC 744 Route 113 N Souderton PA 18964 General <strong>Provider</strong> Montgomery<br />

Dapkute Ingrida 050385 A+ Family <strong>Dental</strong> Care PC 744 Route 113 N Souderton PA 18964 General <strong>Provider</strong> Montgomery<br />

Derosa Daniel 050385 A+ Family <strong>Dental</strong> Care PC 744 Route 113 N Souderton PA 18964 General <strong>Provider</strong> Montgomery<br />

Desai Kaushal 050385 A+ Family <strong>Dental</strong> Care PC 744 Route 113 N Souderton PA 18964 General <strong>Provider</strong> Montgomery<br />

Gajendran Bobby 050385 A+ Family <strong>Dental</strong> Care PC 744 Route 113 N Souderton PA 18964 General <strong>Provider</strong> Montgomery<br />

Gombar Anna 050385 A+ Family <strong>Dental</strong> Care PC 744 Route 113 N Souderton PA 18964 General <strong>Provider</strong> Montgomery<br />

Kopp Anatoliy 050385 A+ Family <strong>Dental</strong> Care PC 744 Route 113 N Souderton PA 18964 General <strong>Provider</strong> Montgomery<br />

Lee Young 050385 A+ Family <strong>Dental</strong> Care PC 744 Route 113 N Souderton PA 18964 General <strong>Provider</strong> Montgomery<br />

Merin Jared 050385 A+ Family <strong>Dental</strong> Care PC 744 Route 113 N Souderton PA 18964 General <strong>Provider</strong> Montgomery<br />

Mitelman Alexandra 050385 A+ Family <strong>Dental</strong> Care PC 744 Route 113 N Souderton PA 18964 General <strong>Provider</strong> Montgomery<br />

Moriarty Sean 050385 A+ Family <strong>Dental</strong> Care PC 744 Route 113 N Souderton PA 18964 General <strong>Provider</strong> Montgomery<br />

Savani Bhaskar 050385 A+ Family <strong>Dental</strong> Care PC 744 Route 113 N Souderton PA 18964 General <strong>Provider</strong> Montgomery<br />

Savani Bhumi 050385 A+ Family <strong>Dental</strong> Care PC 744 Route 113 N Souderton PA 18964 General <strong>Provider</strong> Montgomery<br />

Savani Niranjan 050385 A+ Family <strong>Dental</strong> Care PC 744 Route 113 N Souderton PA 18964 General <strong>Provider</strong> Montgomery<br />

Todd Meredith 050385 A+ Family <strong>Dental</strong> Care PC 744 Route 113 N Souderton PA 18964 General <strong>Provider</strong> Montgomery<br />

Bhatnagar Payal 002580 Aspen <strong>Dental</strong> 841 South 25th Street Easton PA 18045 General <strong>Provider</strong> Northampton<br />

Chadha Chandan 002580 Aspen <strong>Dental</strong> 841 South 25th Street Easton PA 18045 General <strong>Provider</strong> Northampton<br />

Chaudhry Ahmad 002580 Aspen <strong>Dental</strong> 841 South 25th Street Easton PA 18045 General <strong>Provider</strong> Northampton<br />

Kim Peter 002580 Aspen <strong>Dental</strong> 841 South 25th Street Easton PA 18045 General <strong>Provider</strong> Northampton<br />

Malhotra Swati 002580 Aspen <strong>Dental</strong> 841 South 25th Street Easton PA 18045 General <strong>Provider</strong> Northampton<br />

Obaid Michel 002580 Aspen <strong>Dental</strong> 841 South 25th Street Easton PA 18045 General <strong>Provider</strong> Northampton<br />

Rajput Bhumika 002580 Aspen <strong>Dental</strong> 841 South 25th Street Easton PA 18045 General <strong>Provider</strong> Northampton<br />

Sambaraju Haritha 002580 Aspen <strong>Dental</strong> 841 South 25th Street Easton PA 18045 General <strong>Provider</strong> Northampton<br />

Withanachchi Janatha 002580 Aspen <strong>Dental</strong> 841 South 25th Street Easton PA 18045 Endodontist Northampton<br />

Yi Tyler 002580 Aspen <strong>Dental</strong> 841 South 25th Street Easton PA 18045 General <strong>Provider</strong> Northampton<br />

Chacker Laurence 002146 Associated <strong>Dental</strong> Specialties 1601Walnut Street, Suite 201 Philadelphia PA 19102 Periodontist Philadelphia<br />

Weinberg Martin 000905 Drs. Weinberg & Goldberg, D.D.S. 1528 Walnut Street, Suite 1725 Philadelphia PA 19102 General <strong>Provider</strong> Philadelphia<br />

Braid Stanton 001457 Stanton Braid, D.M.D. 1521 Locust Street, Suite 100 Philadelphia PA 19102 Oral Surgeon Philadelphia<br />

Tinkelman Carl 001318 Carl L. Tinkelman, D.M.D., PC 255 South 17th Street, Ste.1806 Philadelphia PA 19103 Endodontist Philadelphia<br />

Aranbayev Yefim 069968 Dentex <strong>Dental</strong> Group Ltd 1625 Chestnut St, Suite 228 Philadelphia PA 19103 General <strong>Provider</strong> Philadelphia<br />

Choi Bokyu 069968 Dentex <strong>Dental</strong> Group Ltd 1625 Chestnut St, Suite 228 Philadelphia PA 19103 General <strong>Provider</strong> Philadelphia<br />

Cohen Ronald 069968 Dentex <strong>Dental</strong> Group Ltd 1625 Chestnut St, Suite 228 Philadelphia PA 19103 General <strong>Provider</strong> Philadelphia<br />

* Indicates dentist that is accepting current patients only.<br />

All <strong>Select</strong> <strong>Plan</strong> Dentists Page 31<br />

1 Same as a DHMO with fixed member copayments, no annual maximum dollar limits, no waiting periods, no deductibles, no pre-authorization paperwork or pre-treatment estimates and no<br />

claim forms or proof of loss (except in the case of out-of-area emergencies). Member must enroll with a General Dentist. Fac ID is used to indicate which facility a member chooses.


SELECT PLAN 1 DENTIST DIRECTORY<br />

Dentists listed are under contract as of 10/1/12<br />

Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />

Genkin Alexander 069968 Dentex <strong>Dental</strong> Group Ltd 1625 Chestnut St, Suite 228 Philadelphia PA 19103 General <strong>Provider</strong> Philadelphia<br />

Go Satoshi 069968 Dentex <strong>Dental</strong> Group Ltd 1625 Chestnut St, Suite 228 Philadelphia PA 19103 General <strong>Provider</strong> Philadelphia<br />

Joo Esther 069968 Dentex <strong>Dental</strong> Group Ltd 1625 Chestnut St, Suite 228 Philadelphia PA 19103 General <strong>Provider</strong> Philadelphia<br />

Kim Nari 069968 Dentex <strong>Dental</strong> Group Ltd 1625 Chestnut St, Suite 228 Philadelphia PA 19103 General <strong>Provider</strong> Philadelphia<br />

Levites Margarita 069968 Dentex <strong>Dental</strong> Group Ltd 1625 Chestnut St, Suite 228 Philadelphia PA 19103 General <strong>Provider</strong> Philadelphia<br />

Moon Daeuk 069968 Dentex <strong>Dental</strong> Group Ltd 1625 Chestnut St, Suite 228 Philadelphia PA 19103 General <strong>Provider</strong> Philadelphia<br />

Plotnik Igor 069968 Dentex <strong>Dental</strong> Group Ltd 1625 Chestnut St, Suite 228 Philadelphia PA 19103 General <strong>Provider</strong> Philadelphia<br />

Sedaghat Shabnam 069968 Dentex <strong>Dental</strong> Group Ltd 1625 Chestnut St, Suite 228 Philadelphia PA 19103 General <strong>Provider</strong> Philadelphia<br />

Zhang Chengfeng 069968 Dentex <strong>Dental</strong> Group Ltd 1625 Chestnut St, Suite 228 Philadelphia PA 19103 General <strong>Provider</strong> Philadelphia<br />

Zilberman Alexander 069968 Dentex <strong>Dental</strong> Group Ltd 1625 Chestnut St, Suite 228 Philadelphia PA 19103 General <strong>Provider</strong> Philadelphia<br />

Yurovsky Renee 038098 Renee Yurovsky DDS PC 1831 Chestnut St, Suite 100 Philadelphia PA 19103 General <strong>Provider</strong> Philadelphia<br />

Wolgin Joshua 079085 Wolgin Endodontic Group 255 S 17th St, Suite 1806 Philadelphia PA 19103 Endodontist Philadelphia<br />

Young Eugene 069549 Dr Young & Associates LLC 4310 Walnut St Philadelphia PA 19104 General <strong>Provider</strong> Philadelphia<br />

Yanez Rafael 068457 All About Your Smile PC 200 Walnut St Philadelphia PA 19106 General <strong>Provider</strong> Philadelphia<br />

Adams Michael 002792 American <strong>Dental</strong> Care, PC 722 Market Street Philadelphia PA 19106 General <strong>Provider</strong> Philadelphia<br />

Blumenthal Mitchel 002792 American <strong>Dental</strong> Care, PC 722 Market Street Philadelphia PA 19106 General <strong>Provider</strong> Philadelphia<br />

Bruno Frank 002792 American <strong>Dental</strong> Care, PC 722 Market Street Philadelphia PA 19106 Endodontist Philadelphia<br />

Chen Yang 002792 American <strong>Dental</strong> Care, PC 722 Market Street Philadelphia PA 19106 General <strong>Provider</strong> Philadelphia<br />

Cohen Hal 002792 American <strong>Dental</strong> Care, PC 722 Market Street Philadelphia PA 19106 General <strong>Provider</strong> Philadelphia<br />

Daly Gerald 002792 American <strong>Dental</strong> Care, PC 722 Market Street Philadelphia PA 19106 General <strong>Provider</strong> Philadelphia<br />

David Dan 002792 American <strong>Dental</strong> Care, PC 722 Market Street Philadelphia PA 19106 General <strong>Provider</strong> Philadelphia<br />

Edmonds R Blake 002792 American <strong>Dental</strong> Care, PC 722 Market Street Philadelphia PA 19106 General <strong>Provider</strong> Philadelphia<br />

Elkhatib Mohammad 002792 American <strong>Dental</strong> Care, PC 722 Market Street Philadelphia PA 19106 General <strong>Provider</strong> Philadelphia<br />

Fluhr Howard 002792 American <strong>Dental</strong> Care, PC 722 Market Street Philadelphia PA 19106 General <strong>Provider</strong> Philadelphia<br />

Gelbart Steven 002792 American <strong>Dental</strong> Care, PC 722 Market Street Philadelphia PA 19106 General <strong>Provider</strong> Philadelphia<br />

Kim Jae Woo 002792 American <strong>Dental</strong> Care, PC 722 Market Street Philadelphia PA 19106 General <strong>Provider</strong> Philadelphia<br />

Kim Steven 002792 American <strong>Dental</strong> Care, PC 722 Market Street Philadelphia PA 19106 Periodontist Philadelphia<br />

Koff Howard 002792 American <strong>Dental</strong> Care, PC 722 Market Street Philadelphia PA 19106 Orthodontist Philadelphia<br />

Levy Jamie 002792 American <strong>Dental</strong> Care, PC 722 Market Street Philadelphia PA 19106 Oral Surgeon Philadelphia<br />

Li Fuming 002792 American <strong>Dental</strong> Care, PC 722 Market Street Philadelphia PA 19106 General <strong>Provider</strong> Philadelphia<br />

Lu John 002792 American <strong>Dental</strong> Care, PC 722 Market Street Philadelphia PA 19106 Periodontist Philadelphia<br />

Mojahed Amir 002792 American <strong>Dental</strong> Care, PC 722 Market Street Philadelphia PA 19106 General <strong>Provider</strong> Philadelphia<br />

Mumtaz Samera 002792 American <strong>Dental</strong> Care, PC 722 Market Street Philadelphia PA 19106 General <strong>Provider</strong> Philadelphia<br />

Nguyen Diep 002792 American <strong>Dental</strong> Care, PC 722 Market Street Philadelphia PA 19106 General <strong>Provider</strong> Philadelphia<br />

Oh Jinsuk 002792 American <strong>Dental</strong> Care, PC 722 Market Street Philadelphia PA 19106 General <strong>Provider</strong> Philadelphia<br />

Pereia Christine 002792 American <strong>Dental</strong> Care, PC 722 Market Street Philadelphia PA 19106 General <strong>Provider</strong> Philadelphia<br />

Roth Michael 002792 American <strong>Dental</strong> Care, PC 722 Market Street Philadelphia PA 19106 Orthodontist Philadelphia<br />

Ruggieri John 002792 American <strong>Dental</strong> Care, PC 722 Market Street Philadelphia PA 19106 General <strong>Provider</strong> Philadelphia<br />

Sacks Frederick 002792 American <strong>Dental</strong> Care, PC 722 Market Street Philadelphia PA 19106 Oral Surgeon Philadelphia<br />

Sandhu Satinder 002792 American <strong>Dental</strong> Care, PC 722 Market Street Philadelphia PA 19106 General <strong>Provider</strong> Philadelphia<br />

Sanfacon Dennis 002792 American <strong>Dental</strong> Care, PC 722 Market Street Philadelphia PA 19106 General <strong>Provider</strong> Philadelphia<br />

Shah Nishit 002792 American <strong>Dental</strong> Care, PC 722 Market Street Philadelphia PA 19106 General <strong>Provider</strong> Philadelphia<br />

Shamseddin Seyed 002792 American <strong>Dental</strong> Care, PC 722 Market Street Philadelphia PA 19106 Periodontist Philadelphia<br />

Sultana Parveen 002792 American <strong>Dental</strong> Care, PC 722 Market Street Philadelphia PA 19106 General <strong>Provider</strong> Philadelphia<br />

Thilak Preetha 002792 American <strong>Dental</strong> Care, PC 722 Market Street Philadelphia PA 19106 General <strong>Provider</strong> Philadelphia<br />

Weinstein Steven 002792 American <strong>Dental</strong> Care, PC 722 Market Street Philadelphia PA 19106 General <strong>Provider</strong> Philadelphia<br />

Yang Qing 002792 American <strong>Dental</strong> Care, PC 722 Market Street Philadelphia PA 19106 General <strong>Provider</strong> Philadelphia<br />

Yao Zheng 002792 American <strong>Dental</strong> Care, PC 722 Market Street Philadelphia PA 19106 General <strong>Provider</strong> Philadelphia<br />

Yoon Simon 002792 American <strong>Dental</strong> Care, PC 722 Market Street Philadelphia PA 19106 General <strong>Provider</strong> Philadelphia<br />

Ghani Mohammad 002261 Advance <strong>Dental</strong> Care Consultants 1225 Vine Street, Suite 401 Philadelphia PA 19107 General <strong>Provider</strong> Philadelphia<br />

* Young Eugene 001194 Dr Young & Associates LLC 924 Arch St. Philadelphia PA 19107 General <strong>Provider</strong> Philadelphia<br />

Paul Prolay 050725 Gallery Mall <strong>Dental</strong> PC 901 Market St, Space 3220 Philadelphia PA 19107 General <strong>Provider</strong> Philadelphia<br />

Shah Shreyas 050725 Gallery Mall <strong>Dental</strong> PC 901 Market St, Space 3220 Philadelphia PA 19107 General <strong>Provider</strong> Philadelphia<br />

Cho Sung 050455 Jefferson Oral & Maxillofacial Surgery 909 Walnut St, Suite 300 COB Philadelphia PA 19107 Oral Surgeon Philadelphia<br />

Diecidue Robert 050455 Jefferson Oral & Maxillofacial Surgery 909 Walnut St, Suite 300 COB Philadelphia PA 19107 Oral Surgeon Philadelphia<br />

Taub Daniel 050455 Jefferson Oral & Maxillofacial Surgery 909 Walnut St, Suite 300 COB Philadelphia PA 19107 Oral Surgeon Philadelphia<br />

Bahram Ramin 078260 Oral Surgery Consultants of PA 1601 Walnut Street, Suite 1207 Philadelphia PA 19107 Oral Surgeon Philadelphia<br />

Bowser Daniel 078260 Oral Surgery Consultants of PA 1601 Walnut Street, Suite 1207 Philadelphia PA 19107 Oral Surgeon Philadelphia<br />

Richman Brad 078260 Oral Surgery Consultants of PA 1601 Walnut Street, Suite 1207 Philadelphia PA 19107 Oral Surgeon Philadelphia<br />

Donskoy Jennifer 051123 DentaLux LLC 1308 Cottman Ave Philadelphia PA 19111 General <strong>Provider</strong> Philadelphia<br />

Goldberg Robert 051123 DentaLux LLC 1308 Cottman Ave Philadelphia PA 19111 General <strong>Provider</strong> Philadelphia<br />

Aranbayev Yefim 069969 Dentex <strong>Dental</strong> Group Ltd 6227 Rising Sun Ave Philadelphia PA 19111 General <strong>Provider</strong> Philadelphia<br />

Choi Bokyu 069969 Dentex <strong>Dental</strong> Group Ltd 6227 Rising Sun Ave Philadelphia PA 19111 General <strong>Provider</strong> Philadelphia<br />

Cohen Ronald 069969 Dentex <strong>Dental</strong> Group Ltd 6227 Rising Sun Ave Philadelphia PA 19111 General <strong>Provider</strong> Philadelphia<br />

Genkin Alexander 069969 Dentex <strong>Dental</strong> Group Ltd 6227 Rising Sun Ave Philadelphia PA 19111 General <strong>Provider</strong> Philadelphia<br />

Go Satoshi 069969 Dentex <strong>Dental</strong> Group Ltd 6227 Rising Sun Ave Philadelphia PA 19111 General <strong>Provider</strong> Philadelphia<br />

* Indicates dentist that is accepting current patients only.<br />

All <strong>Select</strong> <strong>Plan</strong> Dentists Page 32<br />

1 Same as a DHMO with fixed member copayments, no annual maximum dollar limits, no waiting periods, no deductibles, no pre-authorization paperwork or pre-treatment estimates and no<br />

claim forms or proof of loss (except in the case of out-of-area emergencies). Member must enroll with a General Dentist. Fac ID is used to indicate which facility a member chooses.


SELECT PLAN 1 DENTIST DIRECTORY<br />

Dentists listed are under contract as of 10/1/12<br />

Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />

Joo Esther 069969 Dentex <strong>Dental</strong> Group Ltd 6227 Rising Sun Ave Philadelphia PA 19111 General <strong>Provider</strong> Philadelphia<br />

Kim Nari 069969 Dentex <strong>Dental</strong> Group Ltd 6227 Rising Sun Ave Philadelphia PA 19111 General <strong>Provider</strong> Philadelphia<br />

Levites Margarita 069969 Dentex <strong>Dental</strong> Group Ltd 6227 Rising Sun Ave Philadelphia PA 19111 General <strong>Provider</strong> Philadelphia<br />

Moon Daeuk 069969 Dentex <strong>Dental</strong> Group Ltd 6227 Rising Sun Ave Philadelphia PA 19111 General <strong>Provider</strong> Philadelphia<br />

Plotnik Igor 069969 Dentex <strong>Dental</strong> Group Ltd 6227 Rising Sun Ave Philadelphia PA 19111 General <strong>Provider</strong> Philadelphia<br />

Sedaghat Shabnam 069969 Dentex <strong>Dental</strong> Group Ltd 6227 Rising Sun Ave Philadelphia PA 19111 General <strong>Provider</strong> Philadelphia<br />

Zhang Chengfeng 069969 Dentex <strong>Dental</strong> Group Ltd 6227 Rising Sun Ave Philadelphia PA 19111 General <strong>Provider</strong> Philadelphia<br />

Zilberman Alexander 069969 Dentex <strong>Dental</strong> Group Ltd 6227 Rising Sun Ave Philadelphia PA 19111 General <strong>Provider</strong> Philadelphia<br />

Chadhalavada Kavitha 068449 Eastern <strong>Dental</strong> Associates of Cottman Avenue 1936 Cottman Ave Philadelphia PA 19111 General <strong>Provider</strong> Philadelphia<br />

Vora Vasant 000838 Vasant K. Vora, D.D.S. 907 Tyson Ave, PO Box 11436 Philadelphia PA 19111 General <strong>Provider</strong> Philadelphia<br />

Adams Michael 002797 American <strong>Dental</strong> Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General <strong>Provider</strong> Philadelphia<br />

Blumenthal Mitchel 002797 American <strong>Dental</strong> Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General <strong>Provider</strong> Philadelphia<br />

Bruno Frank 002797 American <strong>Dental</strong> Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 Endodontist Philadelphia<br />

Chen Yang 002797 American <strong>Dental</strong> Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General <strong>Provider</strong> Philadelphia<br />

Cohen Hal 002797 American <strong>Dental</strong> Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General <strong>Provider</strong> Philadelphia<br />

Daly Gerald 002797 American <strong>Dental</strong> Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General <strong>Provider</strong> Philadelphia<br />

David Dan 002797 American <strong>Dental</strong> Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General <strong>Provider</strong> Philadelphia<br />

Edmonds R Blake 002797 American <strong>Dental</strong> Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General <strong>Provider</strong> Philadelphia<br />

Elkhatib Mohammad 002797 American <strong>Dental</strong> Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General <strong>Provider</strong> Philadelphia<br />

Fluhr Howard 002797 American <strong>Dental</strong> Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General <strong>Provider</strong> Philadelphia<br />

Gelbart Steven 002797 American <strong>Dental</strong> Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General <strong>Provider</strong> Philadelphia<br />

Kim Jae Woo 002797 American <strong>Dental</strong> Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General <strong>Provider</strong> Philadelphia<br />

Kim Steven 002797 American <strong>Dental</strong> Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 Periodontist Philadelphia<br />

Koff Howard 002797 American <strong>Dental</strong> Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 Orthodontist Philadelphia<br />

Levy Jamie 002797 American <strong>Dental</strong> Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 Oral Surgeon Philadelphia<br />

Li Fuming 002797 American <strong>Dental</strong> Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General <strong>Provider</strong> Philadelphia<br />

Lu John 002797 American <strong>Dental</strong> Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 Periodontist Philadelphia<br />

Mojahed Amir 002797 American <strong>Dental</strong> Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General <strong>Provider</strong> Philadelphia<br />

Mumtaz Samera 002797 American <strong>Dental</strong> Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General <strong>Provider</strong> Philadelphia<br />

Nguyen Diep 002797 American <strong>Dental</strong> Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General <strong>Provider</strong> Philadelphia<br />

Oh Jinsuk 002797 American <strong>Dental</strong> Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General <strong>Provider</strong> Philadelphia<br />

Pereia Christine 002797 American <strong>Dental</strong> Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General <strong>Provider</strong> Philadelphia<br />

Roth Michael 002797 American <strong>Dental</strong> Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 Orthodontist Philadelphia<br />

Ruggieri John 002797 American <strong>Dental</strong> Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General <strong>Provider</strong> Philadelphia<br />

Sacks Frederick 002797 American <strong>Dental</strong> Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 Oral Surgeon Philadelphia<br />

Sandhu Satinder 002797 American <strong>Dental</strong> Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General <strong>Provider</strong> Philadelphia<br />

Sanfacon Dennis 002797 American <strong>Dental</strong> Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General <strong>Provider</strong> Philadelphia<br />

Shah Nishit 002797 American <strong>Dental</strong> Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General <strong>Provider</strong> Philadelphia<br />

Sultana Parveen 002797 American <strong>Dental</strong> Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General <strong>Provider</strong> Philadelphia<br />

Thilak Preetha 002797 American <strong>Dental</strong> Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General <strong>Provider</strong> Philadelphia<br />

Weinstein Steven 002797 American <strong>Dental</strong> Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General <strong>Provider</strong> Philadelphia<br />

Yang Qing 002797 American <strong>Dental</strong> Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General <strong>Provider</strong> Philadelphia<br />

Yao Zheng 002797 American <strong>Dental</strong> Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General <strong>Provider</strong> Philadelphia<br />

Yoon Simon 002797 American <strong>Dental</strong> Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General <strong>Provider</strong> Philadelphia<br />

Bresler David 001580 David A Bresler DDS PC 240 Geiger Rd. Philadelphia PA 19115 Pedodontist Philadelphia<br />

Bresler Jason 001580 David A Bresler DDS PC 240 Geiger Rd. Philadelphia PA 19115 Pedodontist Philadelphia<br />

Bresler Joshua 001580 David A Bresler DDS PC 240 Geiger Rd. Philadelphia PA 19115 Pedodontist Philadelphia<br />

Mayzenberg Julia 001580 David A Bresler DDS PC 240 Geiger Rd. Philadelphia PA 19115 Pedodontist Philadelphia<br />

Bresler David 078265 Doc Breslers Cavity Busters 1916 Welsh Rd Philadelphia PA 19115 Pedodontist Philadelphia<br />

Bresler Jason 078265 Doc Breslers Cavity Busters 1916 Welsh Rd Philadelphia PA 19115 Pedodontist Philadelphia<br />

Bresler Joshua 078265 Doc Breslers Cavity Busters 1916 Welsh Rd Philadelphia PA 19115 Pedodontist Philadelphia<br />

Jacobson Irving 078265 Doc Breslers Cavity Busters 1916 Welsh Rd Philadelphia PA 19115 Pedodontist Philadelphia<br />

Mayzenberg Julia 078265 Doc Breslers Cavity Busters 1916 Welsh Rd Philadelphia PA 19115 Pedodontist Philadelphia<br />

Uppal Gagan 050646 AC <strong>Dental</strong> of NE Philly 10000 Roosevelt Blvd Philadelphia PA 19116 General <strong>Provider</strong> Philadelphia<br />

Burdo Gregory 069987 Da Vinci <strong>Dental</strong> Specialists 10108 Bustleton Ave Philadelphia PA 19116 Periodontist Philadelphia<br />

Aranbayev Yefim 069572 Dentex <strong>Dental</strong> Group Ltd 10108 Bustleton Ave Philadelphia PA 19116 General <strong>Provider</strong> Philadelphia<br />

Choi Bokyu 069572 Dentex <strong>Dental</strong> Group Ltd 10108 Bustleton Ave Philadelphia PA 19116 General <strong>Provider</strong> Philadelphia<br />

Cohen Ronald 069572 Dentex <strong>Dental</strong> Group Ltd 10108 Bustleton Ave Philadelphia PA 19116 General <strong>Provider</strong> Philadelphia<br />

Genkin Alexander 069572 Dentex <strong>Dental</strong> Group Ltd 10108 Bustleton Ave Philadelphia PA 19116 General <strong>Provider</strong> Philadelphia<br />

Go Satoshi 069572 Dentex <strong>Dental</strong> Group Ltd 10108 Bustleton Ave Philadelphia PA 19116 General <strong>Provider</strong> Philadelphia<br />

Joo Esther 069572 Dentex <strong>Dental</strong> Group Ltd 10108 Bustleton Ave Philadelphia PA 19116 General <strong>Provider</strong> Philadelphia<br />

Kim Nari 069572 Dentex <strong>Dental</strong> Group Ltd 10108 Bustleton Ave Philadelphia PA 19116 General <strong>Provider</strong> Philadelphia<br />

Levites Margarita 069572 Dentex <strong>Dental</strong> Group Ltd 10108 Bustleton Ave Philadelphia PA 19116 General <strong>Provider</strong> Philadelphia<br />

Moon Daeuk 069572 Dentex <strong>Dental</strong> Group Ltd 10108 Bustleton Ave Philadelphia PA 19116 General <strong>Provider</strong> Philadelphia<br />

Plotnik Igor 069572 Dentex <strong>Dental</strong> Group Ltd 10108 Bustleton Ave Philadelphia PA 19116 General <strong>Provider</strong> Philadelphia<br />

Sedaghat Shabnam 069572 Dentex <strong>Dental</strong> Group Ltd 10108 Bustleton Ave Philadelphia PA 19116 General <strong>Provider</strong> Philadelphia<br />

* Indicates dentist that is accepting current patients only.<br />

All <strong>Select</strong> <strong>Plan</strong> Dentists Page 33<br />

1 Same as a DHMO with fixed member copayments, no annual maximum dollar limits, no waiting periods, no deductibles, no pre-authorization paperwork or pre-treatment estimates and no<br />

claim forms or proof of loss (except in the case of out-of-area emergencies). Member must enroll with a General Dentist. Fac ID is used to indicate which facility a member chooses.


SELECT PLAN 1 DENTIST DIRECTORY<br />

Dentists listed are under contract as of 10/1/12<br />

Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />

Zhang Chengfeng 069572 Dentex <strong>Dental</strong> Group Ltd 10108 Bustleton Ave Philadelphia PA 19116 General <strong>Provider</strong> Philadelphia<br />

Zilberman Alexander 069572 Dentex <strong>Dental</strong> Group Ltd 10108 Bustleton Ave Philadelphia PA 19116 General <strong>Provider</strong> Philadelphia<br />

Abraham Kurian 002790 Kurian M. Abraham, D.D.S. 11001 Bustleton Ave. Philadelphia PA 19116 General <strong>Provider</strong> Philadelphia<br />

Amayev Oleg 068524 Northeast <strong>Dental</strong> Center 10847 Bustleton Ave Philadelphia PA 19116 General <strong>Provider</strong> Philadelphia<br />

Patoliya Keyur 080785 Advanced <strong>Dental</strong> Designs, PC 6529 Gernamtown Ave Philadelphia PA 19119 General <strong>Provider</strong> Philadelphia<br />

Panossian Antoine 070974 A+ Oral Surgery Specialty Care PC 600 W Olney Ave Philadelphia PA 19120 Oral Surgeon Philadelphia<br />

Tran David 070974 A+ Oral Surgery Specialty Care PC 600 W Olney Ave Philadelphia PA 19120 Oral Surgeon Philadelphia<br />

Abdelkader Ahmed 069557 Abdelkader Family Dentistry 358 E Wyoming Ave Philadelphia PA 19120 General <strong>Provider</strong> Philadelphia<br />

Agrawal Avanti 002355 Advanced Family Dentistry PC 600 West Olney Avenue Philadelphia PA 19120 General <strong>Provider</strong> Philadelphia<br />

Ahmadzadeh Bijan 002355 Advanced Family Dentistry PC 600 West Olney Avenue Philadelphia PA 19120 General <strong>Provider</strong> Philadelphia<br />

Dapkute Ingrida 002355 Advanced Family Dentistry PC 600 West Olney Avenue Philadelphia PA 19120 General <strong>Provider</strong> Philadelphia<br />

Derosa Daniel 002355 Advanced Family Dentistry PC 600 West Olney Avenue Philadelphia PA 19120 General <strong>Provider</strong> Philadelphia<br />

Desai Kaushal 002355 Advanced Family Dentistry PC 600 West Olney Avenue Philadelphia PA 19120 General <strong>Provider</strong> Philadelphia<br />

Dhyllon Amen 002355 Advanced Family Dentistry PC 600 West Olney Avenue Philadelphia PA 19120 General <strong>Provider</strong> Philadelphia<br />

Gherca Mirabela 002355 Advanced Family Dentistry PC 600 West Olney Avenue Philadelphia PA 19120 General <strong>Provider</strong> Philadelphia<br />

Gombar Anna 002355 Advanced Family Dentistry PC 600 West Olney Avenue Philadelphia PA 19120 General <strong>Provider</strong> Philadelphia<br />

Hwang Sookie 002355 Advanced Family Dentistry PC 600 West Olney Avenue Philadelphia PA 19120 General <strong>Provider</strong> Philadelphia<br />

Iheoma Esochi 002355 Advanced Family Dentistry PC 600 West Olney Avenue Philadelphia PA 19120 General <strong>Provider</strong> Philadelphia<br />

Kim Angie 002355 Advanced Family Dentistry PC 600 West Olney Avenue Philadelphia PA 19120 General <strong>Provider</strong> Philadelphia<br />

Kopp Anatoliy 002355 Advanced Family Dentistry PC 600 West Olney Avenue Philadelphia PA 19120 General <strong>Provider</strong> Philadelphia<br />

Merin Jared 002355 Advanced Family Dentistry PC 600 West Olney Avenue Philadelphia PA 19120 General <strong>Provider</strong> Philadelphia<br />

Mitelman Alexandra 002355 Advanced Family Dentistry PC 600 West Olney Avenue Philadelphia PA 19120 General <strong>Provider</strong> Philadelphia<br />

Moriarty Sean 002355 Advanced Family Dentistry PC 600 West Olney Avenue Philadelphia PA 19120 General <strong>Provider</strong> Philadelphia<br />

Savani Bhaskar 002355 Advanced Family Dentistry PC 600 West Olney Avenue Philadelphia PA 19120 General <strong>Provider</strong> Philadelphia<br />

Savani Bhumi 002355 Advanced Family Dentistry PC 600 West Olney Avenue Philadelphia PA 19120 General <strong>Provider</strong> Philadelphia<br />

Savani Niranjan 002355 Advanced Family Dentistry PC 600 West Olney Avenue Philadelphia PA 19120 General <strong>Provider</strong> Philadelphia<br />

Todd Meredith 002355 Advanced Family Dentistry PC 600 West Olney Avenue Philadelphia PA 19120 General <strong>Provider</strong> Philadelphia<br />

* Kim Kook 068535 Kook Kan Kim DMD 5438 N Lawrence St Philadelphia PA 19120 General <strong>Provider</strong> Philadelphia<br />

Ravatez Lisa 001178 Lisa Ann Ravetz, D.M.D. 199 W Champlost Ave. Philadelphia PA 19120 General <strong>Provider</strong> Philadelphia<br />

Saraf Neha 061299 Smiles for Miles <strong>Dental</strong> Group 551 Adams Ave Philadelphia PA 19120 General <strong>Provider</strong> Philadelphia<br />

Berrios Karen 002779 Vaux Family Health Center 2300 W Master St Philadelphia PA 19121 General <strong>Provider</strong> Philadelphia<br />

Crawford Charles 002779 Vaux Family Health Center 2300 W Master St Philadelphia PA 19121 General <strong>Provider</strong> Philadelphia<br />

Frare Robert 002779 Vaux Family Health Center 2300 W Master St Philadelphia PA 19121 General <strong>Provider</strong> Philadelphia<br />

Hussain Fahmida 002779 Vaux Family Health Center 2300 W Master St Philadelphia PA 19121 General <strong>Provider</strong> Philadelphia<br />

Dheer Nisha 037861 GPHA Frankford Avenue <strong>Dental</strong> Center 4510 Frankford Ave Philadelphia PA 19124 General <strong>Provider</strong> Philadelphia<br />

Drysdale Robert 037861 GPHA Frankford Avenue <strong>Dental</strong> Center 4510 Frankford Ave Philadelphia PA 19124 General <strong>Provider</strong> Philadelphia<br />

Elsey Riina 037861 GPHA Frankford Avenue <strong>Dental</strong> Center 4510 Frankford Ave Philadelphia PA 19124 General <strong>Provider</strong> Philadelphia<br />

Fadl Reem 037861 GPHA Frankford Avenue <strong>Dental</strong> Center 4510 Frankford Ave Philadelphia PA 19124 General <strong>Provider</strong> Philadelphia<br />

Hao Shenquan 037861 GPHA Frankford Avenue <strong>Dental</strong> Center 4510 Frankford Ave Philadelphia PA 19124 General <strong>Provider</strong> Philadelphia<br />

Jackson Julia 037861 GPHA Frankford Avenue <strong>Dental</strong> Center 4510 Frankford Ave Philadelphia PA 19124 Oral Surgeon Philadelphia<br />

Jubiril-Taylor Linda 037861 GPHA Frankford Avenue <strong>Dental</strong> Center 4510 Frankford Ave Philadelphia PA 19124 General <strong>Provider</strong> Philadelphia<br />

Lloyd Arnelle 037861 GPHA Frankford Avenue <strong>Dental</strong> Center 4510 Frankford Ave Philadelphia PA 19124 General <strong>Provider</strong> Philadelphia<br />

Owens Jessica 037861 GPHA Frankford Avenue <strong>Dental</strong> Center 4510 Frankford Ave Philadelphia PA 19124 General <strong>Provider</strong> Philadelphia<br />

Soapes Kenneth 068471 Kenneth J Soapes DMD 1526 Pratt St Philadelphia PA 19124 General <strong>Provider</strong> Philadelphia<br />

Bahn Paul 070983 Pediatric <strong>Dental</strong> Associates 100 E Lehigh Ave Philadelphia PA 19125 Pedodontist Philadelphia<br />

D'Agostino Alegra 070983 Pediatric <strong>Dental</strong> Associates 100 E Lehigh Ave Philadelphia PA 19125 Pedodontist Philadelphia<br />

Hamilton Sharon 070983 Pediatric <strong>Dental</strong> Associates 100 E Lehigh Ave Philadelphia PA 19125 Pedodontist Philadelphia<br />

Kay Lewis 070983 Pediatric <strong>Dental</strong> Associates 100 E Lehigh Ave Philadelphia PA 19125 Pedodontist Philadelphia<br />

Quinn Noah 070983 Pediatric <strong>Dental</strong> Associates 100 E Lehigh Ave Philadelphia PA 19125 Pedodontist Philadelphia<br />

Rosenbaum Michael 070983 Pediatric <strong>Dental</strong> Associates 100 E Lehigh Ave Philadelphia PA 19125 Pedodontist Philadelphia<br />

Thomas Kimberly 070983 Pediatric <strong>Dental</strong> Associates 100 E Lehigh Ave Philadelphia PA 19125 Pedodontist Philadelphia<br />

Adams Michael 002798 American <strong>Dental</strong> Care, PC 6162 Ridge Ave Philadelphia PA 19128 General <strong>Provider</strong> Philadelphia<br />

Bruno Frank 002798 American <strong>Dental</strong> Care, PC 6162 Ridge Ave Philadelphia PA 19128 Endodontist Philadelphia<br />

Chen Yang 002798 American <strong>Dental</strong> Care, PC 6162 Ridge Ave Philadelphia PA 19128 General <strong>Provider</strong> Philadelphia<br />

Cohen Hal 002798 American <strong>Dental</strong> Care, PC 6162 Ridge Ave Philadelphia PA 19128 General <strong>Provider</strong> Philadelphia<br />

Daly Gerald 002798 American <strong>Dental</strong> Care, PC 6162 Ridge Ave Philadelphia PA 19128 General <strong>Provider</strong> Philadelphia<br />

David Dan 002798 American <strong>Dental</strong> Care, PC 6162 Ridge Ave Philadelphia PA 19128 General <strong>Provider</strong> Philadelphia<br />

Edmonds R Blake 002798 American <strong>Dental</strong> Care, PC 6162 Ridge Ave Philadelphia PA 19128 General <strong>Provider</strong> Philadelphia<br />

Elkhatib Mohammad 002798 American <strong>Dental</strong> Care, PC 6162 Ridge Ave Philadelphia PA 19128 General <strong>Provider</strong> Philadelphia<br />

Fluhr Howard 002798 American <strong>Dental</strong> Care, PC 6162 Ridge Ave Philadelphia PA 19128 General <strong>Provider</strong> Philadelphia<br />

Gelbart Steven 002798 American <strong>Dental</strong> Care, PC 6162 Ridge Ave Philadelphia PA 19128 General <strong>Provider</strong> Philadelphia<br />

Kim Jae Woo 002798 American <strong>Dental</strong> Care, PC 6162 Ridge Ave Philadelphia PA 19128 General <strong>Provider</strong> Philadelphia<br />

Kim Steven 002798 American <strong>Dental</strong> Care, PC 6162 Ridge Ave Philadelphia PA 19128 Periodontist Philadelphia<br />

Koff Howard 002798 American <strong>Dental</strong> Care, PC 6162 Ridge Ave Philadelphia PA 19128 Orthodontist Philadelphia<br />

Levy Jamie 002798 American <strong>Dental</strong> Care, PC 6162 Ridge Ave Philadelphia PA 19128 Oral Surgeon Philadelphia<br />

Li Fuming 002798 American <strong>Dental</strong> Care, PC 6162 Ridge Ave Philadelphia PA 19128 General <strong>Provider</strong> Philadelphia<br />

* Indicates dentist that is accepting current patients only.<br />

All <strong>Select</strong> <strong>Plan</strong> Dentists Page 34<br />

1 Same as a DHMO with fixed member copayments, no annual maximum dollar limits, no waiting periods, no deductibles, no pre-authorization paperwork or pre-treatment estimates and no<br />

claim forms or proof of loss (except in the case of out-of-area emergencies). Member must enroll with a General Dentist. Fac ID is used to indicate which facility a member chooses.


SELECT PLAN 1 DENTIST DIRECTORY<br />

Dentists listed are under contract as of 10/1/12<br />

Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />

Lu John 002798 American <strong>Dental</strong> Care, PC 6162 Ridge Ave Philadelphia PA 19128 Periodontist Philadelphia<br />

Mojahed Amir 002798 American <strong>Dental</strong> Care, PC 6162 Ridge Ave Philadelphia PA 19128 General <strong>Provider</strong> Philadelphia<br />

Mumtaz Samera 002798 American <strong>Dental</strong> Care, PC 6162 Ridge Ave Philadelphia PA 19128 General <strong>Provider</strong> Philadelphia<br />

Nguyen Diep 002798 American <strong>Dental</strong> Care, PC 6162 Ridge Ave Philadelphia PA 19128 General <strong>Provider</strong> Philadelphia<br />

Oh Jinsuk 002798 American <strong>Dental</strong> Care, PC 6162 Ridge Ave Philadelphia PA 19128 General <strong>Provider</strong> Philadelphia<br />

Pereia Christine 002798 American <strong>Dental</strong> Care, PC 6162 Ridge Ave Philadelphia PA 19128 General <strong>Provider</strong> Philadelphia<br />

Roth Michael 002798 American <strong>Dental</strong> Care, PC 6162 Ridge Ave Philadelphia PA 19128 Orthodontist Philadelphia<br />

Ruggieri John 002798 American <strong>Dental</strong> Care, PC 6162 Ridge Ave Philadelphia PA 19128 General <strong>Provider</strong> Philadelphia<br />

Sandhu Satinder 002798 American <strong>Dental</strong> Care, PC 6162 Ridge Ave Philadelphia PA 19128 General <strong>Provider</strong> Philadelphia<br />

Sanfacon Dennis 002798 American <strong>Dental</strong> Care, PC 6162 Ridge Ave Philadelphia PA 19128 General <strong>Provider</strong> Philadelphia<br />

Shah Nishit 002798 American <strong>Dental</strong> Care, PC 6162 Ridge Ave Philadelphia PA 19128 General <strong>Provider</strong> Philadelphia<br />

Sultana Parveen 002798 American <strong>Dental</strong> Care, PC 6162 Ridge Ave Philadelphia PA 19128 General <strong>Provider</strong> Philadelphia<br />

Thilak Preetha 002798 American <strong>Dental</strong> Care, PC 6162 Ridge Ave Philadelphia PA 19128 General <strong>Provider</strong> Philadelphia<br />

Weinstein Steven 002798 American <strong>Dental</strong> Care, PC 6162 Ridge Ave Philadelphia PA 19128 General <strong>Provider</strong> Philadelphia<br />

Yang Qing 002798 American <strong>Dental</strong> Care, PC 6162 Ridge Ave Philadelphia PA 19128 General <strong>Provider</strong> Philadelphia<br />

Yao Zheng 002798 American <strong>Dental</strong> Care, PC 6162 Ridge Ave Philadelphia PA 19128 General <strong>Provider</strong> Philadelphia<br />

Yoon Simon 002798 American <strong>Dental</strong> Care, PC 6162 Ridge Ave Philadelphia PA 19128 General <strong>Provider</strong> Philadelphia<br />

Bresler David 025054 David A Bresler DDS PC 6801 Ridge Ave Philadelphia PA 19128 Pedodontist Philadelphia<br />

Bresler Jason 025054 David A Bresler DDS PC 6801 Ridge Ave Philadelphia PA 19128 Pedodontist Philadelphia<br />

Bresler Joshua 025054 David A Bresler DDS PC 6801 Ridge Ave Philadelphia PA 19128 Pedodontist Philadelphia<br />

Mayzenberg Julia 025054 David A Bresler DDS PC 6801 Ridge Ave Philadelphia PA 19128 Pedodontist Philadelphia<br />

Plotkin Richard 001039 Richard J. Plotkin, D.M.D. 5735 Ridge Ave Philadelphia PA 19128 Oral Surgeon Philadelphia<br />

Kim Hyosun 068521 East Falls Family Dentistry 3500 Sunnyside Ave Philadelphia PA 19129 General <strong>Provider</strong> Philadelphia<br />

Abraham Kurian 002782 Kurian Abraham, D.D.S. 1825 Spring Garden Street Philadelphia PA 19130 General <strong>Provider</strong> Philadelphia<br />

Dempsey Renee 001196 <strong>Dental</strong> First Corporation 3900 Ford Rd, Suite 12 Philadelphia PA 19131 General <strong>Provider</strong> Philadelphia<br />

Berrios Karen 002780 Quality Community Health Center 2501 West Lehigh Ave. Philadelphia PA 19132 General <strong>Provider</strong> Philadelphia<br />

Crawford Charles 002780 Quality Community Health Center 2501 West Lehigh Ave. Philadelphia PA 19132 General <strong>Provider</strong> Philadelphia<br />

Frare Robert 002780 Quality Community Health Center 2501 West Lehigh Ave. Philadelphia PA 19132 General <strong>Provider</strong> Philadelphia<br />

Hussain Fahmida 002780 Quality Community Health Center 2501 West Lehigh Ave. Philadelphia PA 19132 General <strong>Provider</strong> Philadelphia<br />

Gelman Alexander 069951 Allegheny <strong>Dental</strong> 1 2734 E Allegheny Ave Philadelphia PA 19134 General <strong>Provider</strong> Philadelphia<br />

Khedr Maged 069951 Allegheny <strong>Dental</strong> 1 2734 E Allegheny Ave Philadelphia PA 19134 General <strong>Provider</strong> Philadelphia<br />

Manda Anil 069951 Allegheny <strong>Dental</strong> 1 2734 E Allegheny Ave Philadelphia PA 19134 General <strong>Provider</strong> Philadelphia<br />

Aranbayev Yefim 069970 Dentex <strong>Dental</strong> Group Ltd 2734 E Allegheny Ave Philadelphia PA 19134 General <strong>Provider</strong> Philadelphia<br />

Choi Bokyu 069970 Dentex <strong>Dental</strong> Group Ltd 2734 E Allegheny Ave Philadelphia PA 19134 General <strong>Provider</strong> Philadelphia<br />

Cohen Ronald 069970 Dentex <strong>Dental</strong> Group Ltd 2734 E Allegheny Ave Philadelphia PA 19134 General <strong>Provider</strong> Philadelphia<br />

Genkin Alexander 069970 Dentex <strong>Dental</strong> Group Ltd 2734 E Allegheny Ave Philadelphia PA 19134 General <strong>Provider</strong> Philadelphia<br />

Go Satoshi 069970 Dentex <strong>Dental</strong> Group Ltd 2734 E Allegheny Ave Philadelphia PA 19134 General <strong>Provider</strong> Philadelphia<br />

Joo Esther 069970 Dentex <strong>Dental</strong> Group Ltd 2734 E Allegheny Ave Philadelphia PA 19134 General <strong>Provider</strong> Philadelphia<br />

Levites Margarita 069970 Dentex <strong>Dental</strong> Group Ltd 2734 E Allegheny Ave Philadelphia PA 19134 General <strong>Provider</strong> Philadelphia<br />

Moon Daeuk 069970 Dentex <strong>Dental</strong> Group Ltd 2734 E Allegheny Ave Philadelphia PA 19134 General <strong>Provider</strong> Philadelphia<br />

Plotnik Igor 069970 Dentex <strong>Dental</strong> Group Ltd 2734 E Allegheny Ave Philadelphia PA 19134 General <strong>Provider</strong> Philadelphia<br />

Sedaghat Shabnam 069970 Dentex <strong>Dental</strong> Group Ltd 2734 E Allegheny Ave Philadelphia PA 19134 General <strong>Provider</strong> Philadelphia<br />

Zhang Chengfeng 069970 Dentex <strong>Dental</strong> Group Ltd 2734 E Allegheny Ave Philadelphia PA 19134 General <strong>Provider</strong> Philadelphia<br />

Zilberman Alexander 069970 Dentex <strong>Dental</strong> Group Ltd 2734 E Allegheny Ave Philadelphia PA 19134 General <strong>Provider</strong> Philadelphia<br />

Kondratyeva Natalya 001184 Magic <strong>Dental</strong> Systems 2601 E Allegheny Ave. Philadelphia PA 19134 General <strong>Provider</strong> Philadelphia<br />

Silverman Donald 002776 Peach <strong>Dental</strong> Center 3200 Frankford Ave Philadelphia PA 19134 General <strong>Provider</strong> Philadelphia<br />

Slutsky Harold 000652 Harold Slutsky, D.M.D. 7100 Frankford Avenue Philadelphia PA 19135 Orthodontist Philadelphia<br />

Khelmer Olga 079083 Mayfair <strong>Dental</strong> Center 6412 Frankford Ave, Suite 10 Philadelphia PA 19135 General <strong>Provider</strong> Philadelphia<br />

Sanjay Sowmya 079083 Mayfair <strong>Dental</strong> Center 6412 Frankford Ave, Suite 10 Philadelphia PA 19135 General <strong>Provider</strong> Philadelphia<br />

Barot Ashok 001243 Ashok Barot DDS PC 7519 Torresdale Ave Philadelphia PA 19136 General <strong>Provider</strong> Philadelphia<br />

Reddy Hima 001243 Ashok Barot DDS PC 7519 Torresdale Ave Philadelphia PA 19136 General <strong>Provider</strong> Philadelphia<br />

Kaye Ralph 000711 Mayfair <strong>Dental</strong> Associates, Ltd. 3541 Ryan Avenue Philadelphia PA 19136 Periodontist Philadelphia<br />

Zaim Mazharul 000918 Mazharul H. Zaim, D.D.S. 1915 Washington Lane Philadelphia PA 19138 General <strong>Provider</strong> Philadelphia<br />

Mehta Dhaval 001759 Dhaval Mehta, D.M.D. 17 S. 60th Street Philadelphia PA 19139 General <strong>Provider</strong> Philadelphia<br />

Brown Stanford 001427 Stanford Brown, D.D.S. 5517 Spruce Street Philadelphia PA 19139 General <strong>Provider</strong> Philadelphia<br />

Silber Stanley 002777 5th Street <strong>Dental</strong> Center, <strong>Inc</strong>. 4646 North 5th Street Philadelphia PA 19140 General <strong>Provider</strong> Philadelphia<br />

Aftab Nigar 000372 Family Dentistry 3435 Germantown Ave. Philadelphia PA 19140 General <strong>Provider</strong> Philadelphia<br />

Dheer Nisha 037863 GPHA Huntington Park <strong>Dental</strong> Center 1999 W. Huntington Park Ave Philadelphia PA 19140 General <strong>Provider</strong> Philadelphia<br />

Drysdale Robert 037863 GPHA Huntington Park <strong>Dental</strong> Center 1999 W. Huntington Park Ave Philadelphia PA 19140 General <strong>Provider</strong> Philadelphia<br />

Elsey Riina 037863 GPHA Huntington Park <strong>Dental</strong> Center 1999 W. Huntington Park Ave Philadelphia PA 19140 General <strong>Provider</strong> Philadelphia<br />

Fadl Reem 037863 GPHA Huntington Park <strong>Dental</strong> Center 1999 W. Huntington Park Ave Philadelphia PA 19140 General <strong>Provider</strong> Philadelphia<br />

Hao Shenquan 037863 GPHA Huntington Park <strong>Dental</strong> Center 1999 W. Huntington Park Ave Philadelphia PA 19140 General <strong>Provider</strong> Philadelphia<br />

Jackson Julia 037863 GPHA Huntington Park <strong>Dental</strong> Center 1999 W. Huntington Park Ave Philadelphia PA 19140 Oral Surgeon Philadelphia<br />

Jubiril-Taylor Linda 037863 GPHA Huntington Park <strong>Dental</strong> Center 1999 W. Huntington Park Ave Philadelphia PA 19140 General <strong>Provider</strong> Philadelphia<br />

Lloyd Arnelle 037863 GPHA Huntington Park <strong>Dental</strong> Center 1999 W. Huntington Park Ave Philadelphia PA 19140 General <strong>Provider</strong> Philadelphia<br />

Owens Jessica 037863 GPHA Huntington Park <strong>Dental</strong> Center 1999 W. Huntington Park Ave Philadelphia PA 19140 General <strong>Provider</strong> Philadelphia<br />

* Indicates dentist that is accepting current patients only.<br />

All <strong>Select</strong> <strong>Plan</strong> Dentists Page 35<br />

1 Same as a DHMO with fixed member copayments, no annual maximum dollar limits, no waiting periods, no deductibles, no pre-authorization paperwork or pre-treatment estimates and no<br />

claim forms or proof of loss (except in the case of out-of-area emergencies). Member must enroll with a General Dentist. Fac ID is used to indicate which facility a member chooses.


SELECT PLAN 1 DENTIST DIRECTORY<br />

Dentists listed are under contract as of 10/1/12<br />

Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />

Bahn Paul 070984 Pediatric <strong>Dental</strong> Associates 3509 N Broad St, 6th Fl Temp Children's Med Ctr Philadelphia PA 19140 Pedodontist Philadelphia<br />

D'Agostino Alegra 070984 Pediatric <strong>Dental</strong> Associates 3509 N Broad St, 6th Fl Temp Children's Med Ctr Philadelphia PA 19140 Pedodontist Philadelphia<br />

Hamilton Sharon 070984 Pediatric <strong>Dental</strong> Associates 3509 N Broad St, 6th Fl Temp Children's Med Ctr Philadelphia PA 19140 Pedodontist Philadelphia<br />

Kay Lewis 070984 Pediatric <strong>Dental</strong> Associates 3509 N Broad St, 6th Fl Temp Children's Med Ctr Philadelphia PA 19140 Pedodontist Philadelphia<br />

Quinn Noah 070984 Pediatric <strong>Dental</strong> Associates 3509 N Broad St, 6th Fl Temp Children's Med Ctr Philadelphia PA 19140 Pedodontist Philadelphia<br />

Rosenbaum Michael 070984 Pediatric <strong>Dental</strong> Associates 3509 N Broad St, 6th Fl Temp Children's Med Ctr Philadelphia PA 19140 Pedodontist Philadelphia<br />

Thomas Kimberly 070984 Pediatric <strong>Dental</strong> Associates 3509 N Broad St, 6th Fl Temp Children's Med Ctr Philadelphia PA 19140 Pedodontist Philadelphia<br />

Patel Mukund 001204 Mukund K. Patel, D.D.S., P.C. 4832 N Broad Street Philadelphia PA 19141 General <strong>Provider</strong> Philadelphia<br />

Malik Arif 000853 Arif S. Malik, D.D.S. 6412 Woodland Ave. Philadelphia PA 19142 General <strong>Provider</strong> Philadelphia<br />

Addiego Ben 000968 Harold H. Marcus Associates 7215 W. Passyunk Ave Philadelphia PA 19142 Orthodontist Philadelphia<br />

Marcus Harold 000968 Harold H. Marcus Associates 7215 W. Passyunk Ave Philadelphia PA 19142 General <strong>Provider</strong> Philadelphia<br />

Marcus Joni 000968 Harold H. Marcus Associates 7215 W. Passyunk Ave Philadelphia PA 19142 General <strong>Provider</strong> Philadelphia<br />

Dheer Nisha 051121 GPHA <strong>Dental</strong> & Behavioral Health Care 5501 Woodland Ave Philadelphia PA 19143 General <strong>Provider</strong> Philadelphia<br />

Drysdale Robert 051121 GPHA <strong>Dental</strong> & Behavioral Health Care 5501 Woodland Ave Philadelphia PA 19143 General <strong>Provider</strong> Philadelphia<br />

Elsey Riina 051121 GPHA <strong>Dental</strong> & Behavioral Health Care 5501 Woodland Ave Philadelphia PA 19143 General <strong>Provider</strong> Philadelphia<br />

Fadl Reem 051121 GPHA <strong>Dental</strong> & Behavioral Health Care 5501 Woodland Ave Philadelphia PA 19143 General <strong>Provider</strong> Philadelphia<br />

Hao Shenquan 051121 GPHA <strong>Dental</strong> & Behavioral Health Care 5501 Woodland Ave Philadelphia PA 19143 General <strong>Provider</strong> Philadelphia<br />

Jackson Julia 051121 GPHA <strong>Dental</strong> & Behavioral Health Care 5501 Woodland Ave Philadelphia PA 19143 Oral Surgeon Philadelphia<br />

Jubiril-Taylor Linda 051121 GPHA <strong>Dental</strong> & Behavioral Health Care 5501 Woodland Ave Philadelphia PA 19143 General <strong>Provider</strong> Philadelphia<br />

Lloyd Arnelle 051121 GPHA <strong>Dental</strong> & Behavioral Health Care 5501 Woodland Ave Philadelphia PA 19143 General <strong>Provider</strong> Philadelphia<br />

Owens Jessica 051121 GPHA <strong>Dental</strong> & Behavioral Health Care 5501 Woodland Ave Philadelphia PA 19143 General <strong>Provider</strong> Philadelphia<br />

Vaidya Kanchan 000860 Kanchan C. Vaidya, D.D.S. 5635 Chester Ave. Philadelphia PA 19143 General <strong>Provider</strong> Philadelphia<br />

Larose Chenet 070471 Dr Chenet Larose <strong>Dental</strong> Office 5555 Wissahickon Ave, Suite L10 Philadelphia PA 19144 General <strong>Provider</strong> Philadelphia<br />

* Varnadore Wayne 001337 Family and Implant Dentistry 633 W. Rittenhouse St., C-15 Philadelphia PA 19144 General <strong>Provider</strong> Philadelphia<br />

Wood Robert 070455 Robert Wood DDS 5521 Greene St Philadelphia PA 19144 General <strong>Provider</strong> Philadelphia<br />

Bresler David 037530 David A Bresler DDS PC 1430 Snyder Ave Philadelphia PA 19145 Pedodontist Philadelphia<br />

Bresler Jason 037530 David A Bresler DDS PC 1430 Snyder Ave Philadelphia PA 19145 Pedodontist Philadelphia<br />

Bresler Joshua 037530 David A Bresler DDS PC 1430 Snyder Ave Philadelphia PA 19145 Pedodontist Philadelphia<br />

Mayzenberg Julia 037530 David A Bresler DDS PC 1430 Snyder Ave Philadelphia PA 19145 Pedodontist Philadelphia<br />

Warshowsky Dennis 001042 Dennis Warshowsky, D.M.D. 1638 South 20th St. Philadelphia PA 19145 General <strong>Provider</strong> Philadelphia<br />

Libou Keith 000619 Gentle <strong>Dental</strong> of Oregon LLC 1419 W Oregon Ave Philadelphia PA 19145 General <strong>Provider</strong> Philadelphia<br />

Truong Anne 000619 Gentle <strong>Dental</strong> of Oregon LLC 1419 W Oregon Ave Philadelphia PA 19145 General <strong>Provider</strong> Philadelphia<br />

Dheer Nisha 037864 GPHA Wilson Park <strong>Dental</strong> Center 2520 Snyder Ave Philadelphia PA 19145 General <strong>Provider</strong> Philadelphia<br />

Drysdale Robert 037864 GPHA Wilson Park <strong>Dental</strong> Center 2520 Snyder Ave Philadelphia PA 19145 General <strong>Provider</strong> Philadelphia<br />

Elsey Riina 037864 GPHA Wilson Park <strong>Dental</strong> Center 2520 Snyder Ave Philadelphia PA 19145 General <strong>Provider</strong> Philadelphia<br />

Fadl Reem 037864 GPHA Wilson Park <strong>Dental</strong> Center 2520 Snyder Ave Philadelphia PA 19145 General <strong>Provider</strong> Philadelphia<br />

Hao Shenquan 037864 GPHA Wilson Park <strong>Dental</strong> Center 2520 Snyder Ave Philadelphia PA 19145 General <strong>Provider</strong> Philadelphia<br />

Jackson Julia 037864 GPHA Wilson Park <strong>Dental</strong> Center 2520 Snyder Ave Philadelphia PA 19145 Oral Surgeon Philadelphia<br />

Jubiril-Taylor Linda 037864 GPHA Wilson Park <strong>Dental</strong> Center 2520 Snyder Ave Philadelphia PA 19145 General <strong>Provider</strong> Philadelphia<br />

Lloyd Arnelle 037864 GPHA Wilson Park <strong>Dental</strong> Center 2520 Snyder Ave Philadelphia PA 19145 General <strong>Provider</strong> Philadelphia<br />

Owens Jessica 037864 GPHA Wilson Park <strong>Dental</strong> Center 2520 Snyder Ave Philadelphia PA 19145 General <strong>Provider</strong> Philadelphia<br />

Bahram Ramin 078257 Oral Surgery Consultants of PA 2546 South Broad Street Philadelphia PA 19145 Oral Surgeon Philadelphia<br />

Bowser Daniel 078257 Oral Surgery Consultants of PA 2546 South Broad Street Philadelphia PA 19145 Oral Surgeon Philadelphia<br />

Richman Brad 078257 Oral Surgery Consultants of PA 2546 South Broad Street Philadelphia PA 19145 Oral Surgeon Philadelphia<br />

Cohen Molly 069556 Steven Shipon DDS 22265 S Broad St Philadelphia PA 19145 General <strong>Provider</strong> Philadelphia<br />

Shipon Steven 069556 Steven Shipon DDS 22265 S Broad St Philadelphia PA 19145 General <strong>Provider</strong> Philadelphia<br />

Chae Jae 078263 City <strong>Dental</strong> LLC 1100 Washington Avenue, 2nd Floor, Unit G Philadelphia PA 19147 General <strong>Provider</strong> Philadelphia<br />

Dheer Nisha 051101 GPHA Chinatown <strong>Dental</strong> Center 930 Washington Ave Philadelphia PA 19147 General <strong>Provider</strong> Philadelphia<br />

Drysdale Robert 051101 GPHA Chinatown <strong>Dental</strong> Center 930 Washington Ave Philadelphia PA 19147 General <strong>Provider</strong> Philadelphia<br />

Elsey Riina 051101 GPHA Chinatown <strong>Dental</strong> Center 930 Washington Ave Philadelphia PA 19147 General <strong>Provider</strong> Philadelphia<br />

Fadl Reem 051101 GPHA Chinatown <strong>Dental</strong> Center 930 Washington Ave Philadelphia PA 19147 General <strong>Provider</strong> Philadelphia<br />

Hao Shenquan 051101 GPHA Chinatown <strong>Dental</strong> Center 930 Washington Ave Philadelphia PA 19147 General <strong>Provider</strong> Philadelphia<br />

Jackson Julia 051101 GPHA Chinatown <strong>Dental</strong> Center 930 Washington Ave Philadelphia PA 19147 Oral Surgeon Philadelphia<br />

Jubiril-Taylor Linda 051101 GPHA Chinatown <strong>Dental</strong> Center 930 Washington Ave Philadelphia PA 19147 General <strong>Provider</strong> Philadelphia<br />

Lloyd Arnelle 051101 GPHA Chinatown <strong>Dental</strong> Center 930 Washington Ave Philadelphia PA 19147 General <strong>Provider</strong> Philadelphia<br />

Owens Jessica 051101 GPHA Chinatown <strong>Dental</strong> Center 930 Washington Ave Philadelphia PA 19147 General <strong>Provider</strong> Philadelphia<br />

Ni Hong 051087 Nice Care <strong>Dental</strong> 1311 South St Philadelphia PA 19147 General <strong>Provider</strong> Philadelphia<br />

* Zalavadia Nikunj 050537 Afton Family <strong>Dental</strong> 1815 S Broad St Philadelphia PA 19148 General <strong>Provider</strong> Philadelphia<br />

Aranbayev Yefim 069965 Dentex <strong>Dental</strong> Group Ltd 1701 E Moyamensing Ave Philadelphia PA 19148 General <strong>Provider</strong> Philadelphia<br />

Aranbayev Yefim 069967 Dentex <strong>Dental</strong> Group Ltd 826 W Porter St Philadelphia PA 19148 General <strong>Provider</strong> Philadelphia<br />

Choi Bokyu 069965 Dentex <strong>Dental</strong> Group Ltd 1701 E Moyamensing Ave Philadelphia PA 19148 General <strong>Provider</strong> Philadelphia<br />

Choi Bokyu 069967 Dentex <strong>Dental</strong> Group Ltd 826 W Porter St Philadelphia PA 19148 General <strong>Provider</strong> Philadelphia<br />

Cohen Ronald 069965 Dentex <strong>Dental</strong> Group Ltd 1701 E Moyamensing Ave Philadelphia PA 19148 General <strong>Provider</strong> Philadelphia<br />

Cohen Ronald 069967 Dentex <strong>Dental</strong> Group Ltd 826 W Porter St Philadelphia PA 19148 General <strong>Provider</strong> Philadelphia<br />

Genkin Alexander 069965 Dentex <strong>Dental</strong> Group Ltd 1701 E Moyamensing Ave Philadelphia PA 19148 General <strong>Provider</strong> Philadelphia<br />

Genkin Alexander 069967 Dentex <strong>Dental</strong> Group Ltd 826 W Porter St Philadelphia PA 19148 General <strong>Provider</strong> Philadelphia<br />

* Indicates dentist that is accepting current patients only.<br />

All <strong>Select</strong> <strong>Plan</strong> Dentists Page 36<br />

1 Same as a DHMO with fixed member copayments, no annual maximum dollar limits, no waiting periods, no deductibles, no pre-authorization paperwork or pre-treatment estimates and no<br />

claim forms or proof of loss (except in the case of out-of-area emergencies). Member must enroll with a General Dentist. Fac ID is used to indicate which facility a member chooses.


SELECT PLAN 1 DENTIST DIRECTORY<br />

Dentists listed are under contract as of 10/1/12<br />

Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />

Go Satoshi 069965 Dentex <strong>Dental</strong> Group Ltd 1701 E Moyamensing Ave Philadelphia PA 19148 General <strong>Provider</strong> Philadelphia<br />

Go Satoshi 069967 Dentex <strong>Dental</strong> Group Ltd 826 W Porter St Philadelphia PA 19148 General <strong>Provider</strong> Philadelphia<br />

Joo Esther 069965 Dentex <strong>Dental</strong> Group Ltd 1701 E Moyamensing Ave Philadelphia PA 19148 General <strong>Provider</strong> Philadelphia<br />

Joo Esther 069967 Dentex <strong>Dental</strong> Group Ltd 826 W Porter St Philadelphia PA 19148 General <strong>Provider</strong> Philadelphia<br />

Kim Nari 069965 Dentex <strong>Dental</strong> Group Ltd 1701 E Moyamensing Ave Philadelphia PA 19148 General <strong>Provider</strong> Philadelphia<br />

Kim Nari 069967 Dentex <strong>Dental</strong> Group Ltd 826 W Porter St Philadelphia PA 19148 General <strong>Provider</strong> Philadelphia<br />

Levites Margarita 069965 Dentex <strong>Dental</strong> Group Ltd 1701 E Moyamensing Ave Philadelphia PA 19148 General <strong>Provider</strong> Philadelphia<br />

Levites Margarita 069967 Dentex <strong>Dental</strong> Group Ltd 826 W Porter St Philadelphia PA 19148 General <strong>Provider</strong> Philadelphia<br />

Moon Daeuk 069965 Dentex <strong>Dental</strong> Group Ltd 1701 E Moyamensing Ave Philadelphia PA 19148 General <strong>Provider</strong> Philadelphia<br />

Moon Daeuk 069967 Dentex <strong>Dental</strong> Group Ltd 826 W Porter St Philadelphia PA 19148 General <strong>Provider</strong> Philadelphia<br />

Plotnik Igor 069965 Dentex <strong>Dental</strong> Group Ltd 1701 E Moyamensing Ave Philadelphia PA 19148 General <strong>Provider</strong> Philadelphia<br />

Plotnik Igor 069967 Dentex <strong>Dental</strong> Group Ltd 826 W Porter St Philadelphia PA 19148 General <strong>Provider</strong> Philadelphia<br />

Sedaghat Shabnam 069965 Dentex <strong>Dental</strong> Group Ltd 1701 E Moyamensing Ave Philadelphia PA 19148 General <strong>Provider</strong> Philadelphia<br />

Sedaghat Shabnam 069967 Dentex <strong>Dental</strong> Group Ltd 826 W Porter St Philadelphia PA 19148 General <strong>Provider</strong> Philadelphia<br />

Zhang Chengfeng 069965 Dentex <strong>Dental</strong> Group Ltd 1701 E Moyamensing Ave Philadelphia PA 19148 General <strong>Provider</strong> Philadelphia<br />

Zhang Chengfeng 069967 Dentex <strong>Dental</strong> Group Ltd 826 W Porter St Philadelphia PA 19148 General <strong>Provider</strong> Philadelphia<br />

Zilberman Alexander 069965 Dentex <strong>Dental</strong> Group Ltd 1701 E Moyamensing Ave Philadelphia PA 19148 General <strong>Provider</strong> Philadelphia<br />

Zilberman Alexander 069967 Dentex <strong>Dental</strong> Group Ltd 826 W Porter St Philadelphia PA 19148 General <strong>Provider</strong> Philadelphia<br />

Dheer Nisha 037865 GPHA Snyder Avenue <strong>Dental</strong> Center 640 Snyder Ave Philadelphia PA 19148 General <strong>Provider</strong> Philadelphia<br />

Drysdale Robert 037865 GPHA Snyder Avenue <strong>Dental</strong> Center 640 Snyder Ave Philadelphia PA 19148 General <strong>Provider</strong> Philadelphia<br />

Elsey Riina 037865 GPHA Snyder Avenue <strong>Dental</strong> Center 640 Snyder Ave Philadelphia PA 19148 General <strong>Provider</strong> Philadelphia<br />

Fadl Reem 037865 GPHA Snyder Avenue <strong>Dental</strong> Center 640 Snyder Ave Philadelphia PA 19148 General <strong>Provider</strong> Philadelphia<br />

Hao Shenquan 037865 GPHA Snyder Avenue <strong>Dental</strong> Center 640 Snyder Ave Philadelphia PA 19148 General <strong>Provider</strong> Philadelphia<br />

Jackson Julia 037865 GPHA Snyder Avenue <strong>Dental</strong> Center 640 Snyder Ave Philadelphia PA 19148 Oral Surgeon Philadelphia<br />

Jubiril-Taylor Linda 037865 GPHA Snyder Avenue <strong>Dental</strong> Center 640 Snyder Ave Philadelphia PA 19148 General <strong>Provider</strong> Philadelphia<br />

Lloyd Arnelle 037865 GPHA Snyder Avenue <strong>Dental</strong> Center 640 Snyder Ave Philadelphia PA 19148 General <strong>Provider</strong> Philadelphia<br />

Owens Jessica 037865 GPHA Snyder Avenue <strong>Dental</strong> Center 640 Snyder Ave Philadelphia PA 19148 General <strong>Provider</strong> Philadelphia<br />

Iheoma Esochi 069568 Jeso Advanced Family Dentistry 223 A McClellan St Philadelphia PA 19148 General <strong>Provider</strong> Philadelphia<br />

Lavalla James 068493 Smile Care Center 626 Snyder Ave Philadelphia PA 19148 General <strong>Provider</strong> Philadelphia<br />

Marisiddaiah Satish 068493 Smile Care Center 626 Snyder Ave Philadelphia PA 19148 General <strong>Provider</strong> Philadelphia<br />

O'Reilly Maria 068493 Smile Care Center 626 Snyder Ave Philadelphia PA 19148 Orthodontist Philadelphia<br />

Thurber John 068493 Smile Care Center 626 Snyder Ave Philadelphia PA 19148 General <strong>Provider</strong> Philadelphia<br />

Alten Steven 000494 Steven B Alten, DDS 2529 South Fifth Street Philadelphia PA 19148 General <strong>Provider</strong> Philadelphia<br />

Bruno Frank 069948 Steven Shipon DDS Specialists 22265 S Broad St Philadelphia PA 19148 Endodontist Philadelphia<br />

Cichetti Michael 070994 Cichetti & DelliGatti Orthodontics PC 6404 Roosevelt Blvd, 2nd Floor Philadelphia PA 19149 Orthodontist Philadelphia<br />

DelliGatti Steve 070994 Cichetti & DelliGatti Orthodontics PC 6404 Roosevelt Blvd, 2nd Floor Philadelphia PA 19149 Orthodontist Philadelphia<br />

Milewski Michael 070994 Cichetti & DelliGatti Orthodontics PC 6404 Roosevelt Blvd, 2nd Floor Philadelphia PA 19149 Orthodontist Philadelphia<br />

Orozco Jacob 070994 Cichetti & DelliGatti Orthodontics PC 6404 Roosevelt Blvd, 2nd Floor Philadelphia PA 19149 Orthodontist Philadelphia<br />

Liss Ira 000369 Longshore Family Dentistry 2001 Longshore Ave. Philadelphia PA 19149 General <strong>Provider</strong> Philadelphia<br />

Bahn Paul 070985 Pediatric <strong>Dental</strong> Associates 6404 Roosevelt Blvd Philadelphia PA 19149 Pedodontist Philadelphia<br />

D'Agostino Alegra 070985 Pediatric <strong>Dental</strong> Associates 6404 Roosevelt Blvd Philadelphia PA 19149 Pedodontist Philadelphia<br />

Hamilton Sharon 070985 Pediatric <strong>Dental</strong> Associates 6404 Roosevelt Blvd Philadelphia PA 19149 Pedodontist Philadelphia<br />

Kay Lewis 070985 Pediatric <strong>Dental</strong> Associates 6404 Roosevelt Blvd Philadelphia PA 19149 Pedodontist Philadelphia<br />

Quinn Noah 070985 Pediatric <strong>Dental</strong> Associates 6404 Roosevelt Blvd Philadelphia PA 19149 Pedodontist Philadelphia<br />

Rosenbaum Michael 070985 Pediatric <strong>Dental</strong> Associates 6404 Roosevelt Blvd Philadelphia PA 19149 Pedodontist Philadelphia<br />

Thomas Kimberly 070985 Pediatric <strong>Dental</strong> Associates 6404 Roosevelt Blvd Philadelphia PA 19149 Pedodontist Philadelphia<br />

Barot Ashok 079783 Revere <strong>Dental</strong> 7265 Revere St Philadelphia PA 19149 General <strong>Provider</strong> Philadelphia<br />

He Yuling 079783 Revere <strong>Dental</strong> 7265 Revere St Philadelphia PA 19149 General <strong>Provider</strong> Philadelphia<br />

Jeong Jihyon 079783 Revere <strong>Dental</strong> 7265 Revere St Philadelphia PA 19149 General <strong>Provider</strong> Philadelphia<br />

Patmidi Avanti 079783 Revere <strong>Dental</strong> 7265 Revere St Philadelphia PA 19149 General <strong>Provider</strong> Philadelphia<br />

Rotwein Benjamin 079783 Revere <strong>Dental</strong> 7265 Revere St Philadelphia PA 19149 General <strong>Provider</strong> Philadelphia<br />

Tadisena Archana 079783 Revere <strong>Dental</strong> 7265 Revere St Philadelphia PA 19149 General <strong>Provider</strong> Philadelphia<br />

Agrawal Avanti 072089 Advanced Family Dentistry PC 2630 W Cheltenham Ave Philadelphia PA 19150 General <strong>Provider</strong> Philadelphia<br />

Derosa Daniel 072089 Advanced Family Dentistry PC 2630 W Cheltenham Ave Philadelphia PA 19150 General <strong>Provider</strong> Philadelphia<br />

Desai Kaushal 072089 Advanced Family Dentistry PC 2630 W Cheltenham Ave Philadelphia PA 19150 General <strong>Provider</strong> Philadelphia<br />

Gombar Anna 072089 Advanced Family Dentistry PC 2630 W Cheltenham Ave Philadelphia PA 19150 General <strong>Provider</strong> Philadelphia<br />

Kim Angie 072089 Advanced Family Dentistry PC 2630 W Cheltenham Ave Philadelphia PA 19150 General <strong>Provider</strong> Philadelphia<br />

Kopp Anatoliy 072089 Advanced Family Dentistry PC 2630 W Cheltenham Ave Philadelphia PA 19150 General <strong>Provider</strong> Philadelphia<br />

Savani Bhaskar 072089 Advanced Family Dentistry PC 2630 W Cheltenham Ave Philadelphia PA 19150 General <strong>Provider</strong> Philadelphia<br />

Savani Bhumi 072089 Advanced Family Dentistry PC 2630 W Cheltenham Ave Philadelphia PA 19150 General <strong>Provider</strong> Philadelphia<br />

Savani Niranjan 072089 Advanced Family Dentistry PC 2630 W Cheltenham Ave Philadelphia PA 19150 General <strong>Provider</strong> Philadelphia<br />

Todd Meredith 072089 Advanced Family Dentistry PC 2630 W Cheltenham Ave Philadelphia PA 19150 General <strong>Provider</strong> Philadelphia<br />

Adams Michael 051002 American <strong>Dental</strong> Care, PC 1501 Wadsworth Ave Philadelphia PA 19150 General <strong>Provider</strong> Philadelphia<br />

* Indicates dentist that is accepting current patients only.<br />

All <strong>Select</strong> <strong>Plan</strong> Dentists Page 37<br />

1 Same as a DHMO with fixed member copayments, no annual maximum dollar limits, no waiting periods, no deductibles, no pre-authorization paperwork or pre-treatment estimates and no<br />

claim forms or proof of loss (except in the case of out-of-area emergencies). Member must enroll with a General Dentist. Fac ID is used to indicate which facility a member chooses.


SELECT PLAN 1 DENTIST DIRECTORY<br />

Dentists listed are under contract as of 10/1/12<br />

Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />

Adams Michael 002793 American <strong>Dental</strong> Care, PC 2385 Cheltenham Ave, Cheltenham Square Mall Philadelphia PA 19150 General <strong>Provider</strong> Philadelphia<br />

Bruno Frank 051002 American <strong>Dental</strong> Care, PC 1501 Wadsworth Ave Philadelphia PA 19150 Endodontist Philadelphia<br />

Bruno Frank 002793 American <strong>Dental</strong> Care, PC 2385 Cheltenham Ave, Cheltenham Square Mall Philadelphia PA 19150 Endodontist Philadelphia<br />

Chen Yang 051002 American <strong>Dental</strong> Care, PC 1501 Wadsworth Ave Philadelphia PA 19150 General <strong>Provider</strong> Philadelphia<br />

Chen Yang 002793 American <strong>Dental</strong> Care, PC 2385 Cheltenham Ave, Cheltenham Square Mall Philadelphia PA 19150 General <strong>Provider</strong> Philadelphia<br />

Cohen Hal 051002 American <strong>Dental</strong> Care, PC 1501 Wadsworth Ave Philadelphia PA 19150 General <strong>Provider</strong> Philadelphia<br />

Cohen Hal 002793 American <strong>Dental</strong> Care, PC 2385 Cheltenham Ave, Cheltenham Square Mall Philadelphia PA 19150 General <strong>Provider</strong> Philadelphia<br />

Daly Gerald 051002 American <strong>Dental</strong> Care, PC 1501 Wadsworth Ave Philadelphia PA 19150 General <strong>Provider</strong> Philadelphia<br />

Daly Gerald 002793 American <strong>Dental</strong> Care, PC 2385 Cheltenham Ave, Cheltenham Square Mall Philadelphia PA 19150 General <strong>Provider</strong> Philadelphia<br />

David Dan 051002 American <strong>Dental</strong> Care, PC 1501 Wadsworth Ave Philadelphia PA 19150 General <strong>Provider</strong> Philadelphia<br />

David Dan 002793 American <strong>Dental</strong> Care, PC 2385 Cheltenham Ave, Cheltenham Square Mall Philadelphia PA 19150 General <strong>Provider</strong> Philadelphia<br />

Edmonds R Blake 051002 American <strong>Dental</strong> Care, PC 1501 Wadsworth Ave Philadelphia PA 19150 General <strong>Provider</strong> Philadelphia<br />

Edmonds R Blake 002793 American <strong>Dental</strong> Care, PC 2385 Cheltenham Ave, Cheltenham Square Mall Philadelphia PA 19150 General <strong>Provider</strong> Philadelphia<br />

Elkhatib Mohammad 051002 American <strong>Dental</strong> Care, PC 1501 Wadsworth Ave Philadelphia PA 19150 General <strong>Provider</strong> Philadelphia<br />

Elkhatib Mohammad 002793 American <strong>Dental</strong> Care, PC 2385 Cheltenham Ave, Cheltenham Square Mall Philadelphia PA 19150 General <strong>Provider</strong> Philadelphia<br />

Fluhr Howard 051002 American <strong>Dental</strong> Care, PC 1501 Wadsworth Ave Philadelphia PA 19150 General <strong>Provider</strong> Philadelphia<br />

Fluhr Howard 002793 American <strong>Dental</strong> Care, PC 2385 Cheltenham Ave, Cheltenham Square Mall Philadelphia PA 19150 General <strong>Provider</strong> Philadelphia<br />

Gelbart Steven 051002 American <strong>Dental</strong> Care, PC 1501 Wadsworth Ave Philadelphia PA 19150 General <strong>Provider</strong> Philadelphia<br />

Gelbart Steven 002793 American <strong>Dental</strong> Care, PC 2385 Cheltenham Ave, Cheltenham Square Mall Philadelphia PA 19150 General <strong>Provider</strong> Philadelphia<br />

Kim Jae Woo 051002 American <strong>Dental</strong> Care, PC 1501 Wadsworth Ave Philadelphia PA 19150 General <strong>Provider</strong> Philadelphia<br />

Kim Jae Woo 002793 American <strong>Dental</strong> Care, PC 2385 Cheltenham Ave, Cheltenham Square Mall Philadelphia PA 19150 General <strong>Provider</strong> Philadelphia<br />

Kim Steven 051002 American <strong>Dental</strong> Care, PC 1501 Wadsworth Ave Philadelphia PA 19150 Periodontist Philadelphia<br />

Kim Steven 002793 American <strong>Dental</strong> Care, PC 2385 Cheltenham Ave, Cheltenham Square Mall Philadelphia PA 19150 Periodontist Philadelphia<br />

Koff Howard 051002 American <strong>Dental</strong> Care, PC 1501 Wadsworth Ave Philadelphia PA 19150 Orthodontist Philadelphia<br />

Koff Howard 002793 American <strong>Dental</strong> Care, PC 2385 Cheltenham Ave, Cheltenham Square Mall Philadelphia PA 19150 Orthodontist Philadelphia<br />

Levy Jamie 051002 American <strong>Dental</strong> Care, PC 1501 Wadsworth Ave Philadelphia PA 19150 Oral Surgeon Philadelphia<br />

Levy Jamie 002793 American <strong>Dental</strong> Care, PC 2385 Cheltenham Ave, Cheltenham Square Mall Philadelphia PA 19150 Oral Surgeon Philadelphia<br />

Li Fuming 051002 American <strong>Dental</strong> Care, PC 1501 Wadsworth Ave Philadelphia PA 19150 General <strong>Provider</strong> Philadelphia<br />

Li Fuming 002793 American <strong>Dental</strong> Care, PC 2385 Cheltenham Ave, Cheltenham Square Mall Philadelphia PA 19150 General <strong>Provider</strong> Philadelphia<br />

Lu John 051002 American <strong>Dental</strong> Care, PC 1501 Wadsworth Ave Philadelphia PA 19150 Periodontist Philadelphia<br />

Lu John 002793 American <strong>Dental</strong> Care, PC 2385 Cheltenham Ave, Cheltenham Square Mall Philadelphia PA 19150 Periodontist Philadelphia<br />

Mojahed Amir 051002 American <strong>Dental</strong> Care, PC 1501 Wadsworth Ave Philadelphia PA 19150 General <strong>Provider</strong> Philadelphia<br />

Mojahed Amir 002793 American <strong>Dental</strong> Care, PC 2385 Cheltenham Ave, Cheltenham Square Mall Philadelphia PA 19150 General <strong>Provider</strong> Philadelphia<br />

Mumtaz Samera 051002 American <strong>Dental</strong> Care, PC 1501 Wadsworth Ave Philadelphia PA 19150 General <strong>Provider</strong> Philadelphia<br />

Mumtaz Samera 002793 American <strong>Dental</strong> Care, PC 2385 Cheltenham Ave, Cheltenham Square Mall Philadelphia PA 19150 General <strong>Provider</strong> Philadelphia<br />

Nguyen Diep 051002 American <strong>Dental</strong> Care, PC 1501 Wadsworth Ave Philadelphia PA 19150 General <strong>Provider</strong> Philadelphia<br />

Nguyen Diep 002793 American <strong>Dental</strong> Care, PC 2385 Cheltenham Ave, Cheltenham Square Mall Philadelphia PA 19150 General <strong>Provider</strong> Philadelphia<br />

Oh Jinsuk 051002 American <strong>Dental</strong> Care, PC 1501 Wadsworth Ave Philadelphia PA 19150 General <strong>Provider</strong> Philadelphia<br />

Oh Jinsuk 002793 American <strong>Dental</strong> Care, PC 2385 Cheltenham Ave, Cheltenham Square Mall Philadelphia PA 19150 General <strong>Provider</strong> Philadelphia<br />

Pereia Christine 051002 American <strong>Dental</strong> Care, PC 1501 Wadsworth Ave Philadelphia PA 19150 General <strong>Provider</strong> Philadelphia<br />

Pereia Christine 002793 American <strong>Dental</strong> Care, PC 2385 Cheltenham Ave, Cheltenham Square Mall Philadelphia PA 19150 General <strong>Provider</strong> Philadelphia<br />

Roth Michael 051002 American <strong>Dental</strong> Care, PC 1501 Wadsworth Ave Philadelphia PA 19150 Orthodontist Philadelphia<br />

Roth Michael 002793 American <strong>Dental</strong> Care, PC 2385 Cheltenham Ave, Cheltenham Square Mall Philadelphia PA 19150 Orthodontist Philadelphia<br />

Ruggieri John 051002 American <strong>Dental</strong> Care, PC 1501 Wadsworth Ave Philadelphia PA 19150 General <strong>Provider</strong> Philadelphia<br />

Ruggieri John 002793 American <strong>Dental</strong> Care, PC 2385 Cheltenham Ave, Cheltenham Square Mall Philadelphia PA 19150 General <strong>Provider</strong> Philadelphia<br />

Sandhu Satinder 051002 American <strong>Dental</strong> Care, PC 1501 Wadsworth Ave Philadelphia PA 19150 General <strong>Provider</strong> Philadelphia<br />

Sandhu Satinder 002793 American <strong>Dental</strong> Care, PC 2385 Cheltenham Ave, Cheltenham Square Mall Philadelphia PA 19150 General <strong>Provider</strong> Philadelphia<br />

Sanfacon Dennis 002793 American <strong>Dental</strong> Care, PC 2385 Cheltenham Ave, Cheltenham Square Mall Philadelphia PA 19150 General <strong>Provider</strong> Philadelphia<br />

Shah Nishit 051002 American <strong>Dental</strong> Care, PC 1501 Wadsworth Ave Philadelphia PA 19150 General <strong>Provider</strong> Philadelphia<br />

Shah Nishit 002793 American <strong>Dental</strong> Care, PC 2385 Cheltenham Ave, Cheltenham Square Mall Philadelphia PA 19150 General <strong>Provider</strong> Philadelphia<br />

Shamseddin Seyed 051002 American <strong>Dental</strong> Care, PC 1501 Wadsworth Ave Philadelphia PA 19150 Periodontist Philadelphia<br />

Shamseddin Seyed 002793 American <strong>Dental</strong> Care, PC 2385 Cheltenham Ave, Cheltenham Square Mall Philadelphia PA 19150 Periodontist Philadelphia<br />

Sultana Parveen 051002 American <strong>Dental</strong> Care, PC 1501 Wadsworth Ave Philadelphia PA 19150 General <strong>Provider</strong> Philadelphia<br />

Sultana Parveen 002793 American <strong>Dental</strong> Care, PC 2385 Cheltenham Ave, Cheltenham Square Mall Philadelphia PA 19150 General <strong>Provider</strong> Philadelphia<br />

Thilak Preetha 051002 American <strong>Dental</strong> Care, PC 1501 Wadsworth Ave Philadelphia PA 19150 General <strong>Provider</strong> Philadelphia<br />

Thilak Preetha 002793 American <strong>Dental</strong> Care, PC 2385 Cheltenham Ave, Cheltenham Square Mall Philadelphia PA 19150 General <strong>Provider</strong> Philadelphia<br />

Weinstein Steven 051002 American <strong>Dental</strong> Care, PC 1501 Wadsworth Ave Philadelphia PA 19150 General <strong>Provider</strong> Philadelphia<br />

Weinstein Steven 002793 American <strong>Dental</strong> Care, PC 2385 Cheltenham Ave, Cheltenham Square Mall Philadelphia PA 19150 General <strong>Provider</strong> Philadelphia<br />

Yang Qing 051002 American <strong>Dental</strong> Care, PC 1501 Wadsworth Ave Philadelphia PA 19150 General <strong>Provider</strong> Philadelphia<br />

Yang Qing 002793 American <strong>Dental</strong> Care, PC 2385 Cheltenham Ave, Cheltenham Square Mall Philadelphia PA 19150 General <strong>Provider</strong> Philadelphia<br />

Yao Zheng 051002 American <strong>Dental</strong> Care, PC 1501 Wadsworth Ave Philadelphia PA 19150 General <strong>Provider</strong> Philadelphia<br />

Yao Zheng 002793 American <strong>Dental</strong> Care, PC 2385 Cheltenham Ave, Cheltenham Square Mall Philadelphia PA 19150 General <strong>Provider</strong> Philadelphia<br />

Yoon Simon 051002 American <strong>Dental</strong> Care, PC 1501 Wadsworth Ave Philadelphia PA 19150 General <strong>Provider</strong> Philadelphia<br />

Yoon Simon 002793 American <strong>Dental</strong> Care, PC 2385 Cheltenham Ave, Cheltenham Square Mall Philadelphia PA 19150 General <strong>Provider</strong> Philadelphia<br />

Appiah-Forson Joseph 002191 Joseph Appiah-Forson, D.M.D., MAGD 7901 Limekiln Pike Philadelphia PA 19150 General <strong>Provider</strong> Philadelphia<br />

Chadhalavada Kavitha 068448 Eastern <strong>Dental</strong> Associates of Overbrook 2121 N 63rd Street Philadelphia PA 19151 General <strong>Provider</strong> Philadelphia<br />

* Indicates dentist that is accepting current patients only.<br />

All <strong>Select</strong> <strong>Plan</strong> Dentists Page 38<br />

1 Same as a DHMO with fixed member copayments, no annual maximum dollar limits, no waiting periods, no deductibles, no pre-authorization paperwork or pre-treatment estimates and no<br />

claim forms or proof of loss (except in the case of out-of-area emergencies). Member must enroll with a General Dentist. Fac ID is used to indicate which facility a member chooses.


SELECT PLAN 1 DENTIST DIRECTORY<br />

Dentists listed are under contract as of 10/1/12<br />

Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />

Agrawal Avanti 050384 A 1 Family <strong>Dental</strong> Care PC 8001 Roosevelt Blvd, Suite 503 Philadelphia PA 19152 General <strong>Provider</strong> Philadelphia<br />

Agrawal Avanti 002351 A 1 Family <strong>Dental</strong> Care PC 8355 Loretto Avenue, Suite 104 Philadelphia PA 19152 General <strong>Provider</strong> Philadelphia<br />

Agrawal Avanti 000392 A 1 Family <strong>Dental</strong> Care PC 8539 Bustleton Ave. Philadelphia PA 19152 General <strong>Provider</strong> Philadelphia<br />

Ahmadzadeh Bijan 050384 A 1 Family <strong>Dental</strong> Care PC 8001 Roosevelt Blvd, Suite 503 Philadelphia PA 19152 General <strong>Provider</strong> Philadelphia<br />

Ahmadzadeh Bijan 002351 A 1 Family <strong>Dental</strong> Care PC 8355 Loretto Avenue, Suite 104 Philadelphia PA 19152 General <strong>Provider</strong> Philadelphia<br />

Ahmadzadeh Bijan 000392 A 1 Family <strong>Dental</strong> Care PC 8539 Bustleton Ave. Philadelphia PA 19152 General <strong>Provider</strong> Philadelphia<br />

Dapkute Ingrida 050384 A 1 Family <strong>Dental</strong> Care PC 8001 Roosevelt Blvd, Suite 503 Philadelphia PA 19152 General <strong>Provider</strong> Philadelphia<br />

Dapkute Ingrida 002351 A 1 Family <strong>Dental</strong> Care PC 8355 Loretto Avenue, Suite 104 Philadelphia PA 19152 General <strong>Provider</strong> Philadelphia<br />

Dapkute Ingrida 000392 A 1 Family <strong>Dental</strong> Care PC 8539 Bustleton Ave. Philadelphia PA 19152 General <strong>Provider</strong> Philadelphia<br />

Derosa Daniel 050384 A 1 Family <strong>Dental</strong> Care PC 8001 Roosevelt Blvd, Suite 503 Philadelphia PA 19152 General <strong>Provider</strong> Philadelphia<br />

Derosa Daniel 002351 A 1 Family <strong>Dental</strong> Care PC 8355 Loretto Avenue, Suite 104 Philadelphia PA 19152 General <strong>Provider</strong> Philadelphia<br />

Derosa Daniel 000392 A 1 Family <strong>Dental</strong> Care PC 8539 Bustleton Ave. Philadelphia PA 19152 General <strong>Provider</strong> Philadelphia<br />

Desai Kaushal 050384 A 1 Family <strong>Dental</strong> Care PC 8001 Roosevelt Blvd, Suite 503 Philadelphia PA 19152 General <strong>Provider</strong> Philadelphia<br />

Desai Kaushal 002351 A 1 Family <strong>Dental</strong> Care PC 8355 Loretto Avenue, Suite 104 Philadelphia PA 19152 General <strong>Provider</strong> Philadelphia<br />

Desai Kaushal 000392 A 1 Family <strong>Dental</strong> Care PC 8539 Bustleton Ave. Philadelphia PA 19152 General <strong>Provider</strong> Philadelphia<br />

Dhyllon Amen 050384 A 1 Family <strong>Dental</strong> Care PC 8001 Roosevelt Blvd, Suite 503 Philadelphia PA 19152 General <strong>Provider</strong> Philadelphia<br />

Gombar Anna 050384 A 1 Family <strong>Dental</strong> Care PC 8001 Roosevelt Blvd, Suite 503 Philadelphia PA 19152 General <strong>Provider</strong> Philadelphia<br />

Gombar Anna 002351 A 1 Family <strong>Dental</strong> Care PC 8355 Loretto Avenue, Suite 104 Philadelphia PA 19152 General <strong>Provider</strong> Philadelphia<br />

Gombar Anna 000392 A 1 Family <strong>Dental</strong> Care PC 8539 Bustleton Ave. Philadelphia PA 19152 General <strong>Provider</strong> Philadelphia<br />

Hoang Mark 050384 A 1 Family <strong>Dental</strong> Care PC 8001 Roosevelt Blvd, Suite 503 Philadelphia PA 19152 General <strong>Provider</strong> Philadelphia<br />

Katikaneni Ramkumar 002351 A 1 Family <strong>Dental</strong> Care PC 8355 Loretto Avenue, Suite 104 Philadelphia PA 19152 General <strong>Provider</strong> Philadelphia<br />

Kim Angie 000392 A 1 Family <strong>Dental</strong> Care PC 8539 Bustleton Ave. Philadelphia PA 19152 General <strong>Provider</strong> Philadelphia<br />

Kopp Anatoliy 050384 A 1 Family <strong>Dental</strong> Care PC 8001 Roosevelt Blvd, Suite 503 Philadelphia PA 19152 General <strong>Provider</strong> Philadelphia<br />

Kopp Anatoliy 002351 A 1 Family <strong>Dental</strong> Care PC 8355 Loretto Avenue, Suite 104 Philadelphia PA 19152 General <strong>Provider</strong> Philadelphia<br />

Kopp Anatoliy 000392 A 1 Family <strong>Dental</strong> Care PC 8539 Bustleton Ave. Philadelphia PA 19152 General <strong>Provider</strong> Philadelphia<br />

Merin Jared 050384 A 1 Family <strong>Dental</strong> Care PC 8001 Roosevelt Blvd, Suite 503 Philadelphia PA 19152 General <strong>Provider</strong> Philadelphia<br />

Merin Jared 002351 A 1 Family <strong>Dental</strong> Care PC 8355 Loretto Avenue, Suite 104 Philadelphia PA 19152 General <strong>Provider</strong> Philadelphia<br />

Merin Jared 000392 A 1 Family <strong>Dental</strong> Care PC 8539 Bustleton Ave. Philadelphia PA 19152 General <strong>Provider</strong> Philadelphia<br />

Miller Andrew 002351 A 1 Family <strong>Dental</strong> Care PC 8355 Loretto Avenue, Suite 104 Philadelphia PA 19152 General <strong>Provider</strong> Philadelphia<br />

Mitelman Alexandra 050384 A 1 Family <strong>Dental</strong> Care PC 8001 Roosevelt Blvd, Suite 503 Philadelphia PA 19152 General <strong>Provider</strong> Philadelphia<br />

Mitelman Alexandra 002351 A 1 Family <strong>Dental</strong> Care PC 8355 Loretto Avenue, Suite 104 Philadelphia PA 19152 General <strong>Provider</strong> Philadelphia<br />

Mitelman Alexandra 000392 A 1 Family <strong>Dental</strong> Care PC 8539 Bustleton Ave. Philadelphia PA 19152 General <strong>Provider</strong> Philadelphia<br />

Moriarty Sean 050384 A 1 Family <strong>Dental</strong> Care PC 8001 Roosevelt Blvd, Suite 503 Philadelphia PA 19152 General <strong>Provider</strong> Philadelphia<br />

Moriarty Sean 002351 A 1 Family <strong>Dental</strong> Care PC 8355 Loretto Avenue, Suite 104 Philadelphia PA 19152 General <strong>Provider</strong> Philadelphia<br />

Moriarty Sean 000392 A 1 Family <strong>Dental</strong> Care PC 8539 Bustleton Ave. Philadelphia PA 19152 General <strong>Provider</strong> Philadelphia<br />

Park Charlie 050384 A 1 Family <strong>Dental</strong> Care PC 8001 Roosevelt Blvd, Suite 503 Philadelphia PA 19152 General <strong>Provider</strong> Philadelphia<br />

Park Charlie 000392 A 1 Family <strong>Dental</strong> Care PC 8539 Bustleton Ave. Philadelphia PA 19152 General <strong>Provider</strong> Philadelphia<br />

Park Jikyung 050384 A 1 Family <strong>Dental</strong> Care PC 8001 Roosevelt Blvd, Suite 503 Philadelphia PA 19152 General <strong>Provider</strong> Philadelphia<br />

Park Jikyung 000392 A 1 Family <strong>Dental</strong> Care PC 8539 Bustleton Ave. Philadelphia PA 19152 General <strong>Provider</strong> Philadelphia<br />

Patel Snehal 000392 A 1 Family <strong>Dental</strong> Care PC 8539 Bustleton Ave. Philadelphia PA 19152 General <strong>Provider</strong> Philadelphia<br />

Purtuc Cynthia 002351 A 1 Family <strong>Dental</strong> Care PC 8355 Loretto Avenue, Suite 104 Philadelphia PA 19152 General <strong>Provider</strong> Philadelphia<br />

Savani Bhaskar 050384 A 1 Family <strong>Dental</strong> Care PC 8001 Roosevelt Blvd, Suite 503 Philadelphia PA 19152 General <strong>Provider</strong> Philadelphia<br />

Savani Bhaskar 002351 A 1 Family <strong>Dental</strong> Care PC 8355 Loretto Avenue, Suite 104 Philadelphia PA 19152 General <strong>Provider</strong> Philadelphia<br />

Savani Bhaskar 000392 A 1 Family <strong>Dental</strong> Care PC 8539 Bustleton Ave. Philadelphia PA 19152 General <strong>Provider</strong> Philadelphia<br />

Savani Bhumi 050384 A 1 Family <strong>Dental</strong> Care PC 8001 Roosevelt Blvd, Suite 503 Philadelphia PA 19152 General <strong>Provider</strong> Philadelphia<br />

Savani Bhumi 002351 A 1 Family <strong>Dental</strong> Care PC 8355 Loretto Avenue, Suite 104 Philadelphia PA 19152 General <strong>Provider</strong> Philadelphia<br />

Savani Bhumi 000392 A 1 Family <strong>Dental</strong> Care PC 8539 Bustleton Ave. Philadelphia PA 19152 General <strong>Provider</strong> Philadelphia<br />

Savani Niranjan 050384 A 1 Family <strong>Dental</strong> Care PC 8001 Roosevelt Blvd, Suite 503 Philadelphia PA 19152 General <strong>Provider</strong> Philadelphia<br />

Savani Niranjan 002351 A 1 Family <strong>Dental</strong> Care PC 8355 Loretto Avenue, Suite 104 Philadelphia PA 19152 General <strong>Provider</strong> Philadelphia<br />

Savani Niranjan 000392 A 1 Family <strong>Dental</strong> Care PC 8539 Bustleton Ave. Philadelphia PA 19152 General <strong>Provider</strong> Philadelphia<br />

Shah Ramesh 000392 A 1 Family <strong>Dental</strong> Care PC 8539 Bustleton Ave. Philadelphia PA 19152 General <strong>Provider</strong> Philadelphia<br />

Todd Meredith 050384 A 1 Family <strong>Dental</strong> Care PC 8001 Roosevelt Blvd, Suite 503 Philadelphia PA 19152 General <strong>Provider</strong> Philadelphia<br />

Todd Meredith 002351 A 1 Family <strong>Dental</strong> Care PC 8355 Loretto Avenue, Suite 104 Philadelphia PA 19152 General <strong>Provider</strong> Philadelphia<br />

Todd Meredith 000392 A 1 Family <strong>Dental</strong> Care PC 8539 Bustleton Ave. Philadelphia PA 19152 General <strong>Provider</strong> Philadelphia<br />

Vinogradov Yelena 002351 A 1 Family <strong>Dental</strong> Care PC 8355 Loretto Avenue, Suite 104 Philadelphia PA 19152 General <strong>Provider</strong> Philadelphia<br />

Vinogradov Yelena 000392 A 1 Family <strong>Dental</strong> Care PC 8539 Bustleton Ave. Philadelphia PA 19152 General <strong>Provider</strong> Philadelphia<br />

Xu Lei 002351 A 1 Family <strong>Dental</strong> Care PC 8355 Loretto Avenue, Suite 104 Philadelphia PA 19152 General <strong>Provider</strong> Philadelphia<br />

Panossian Antoine 070972 A+ Oral Surgery Specialty Care PC 8355 Loretto Ave, Suite 104 Philadelphia PA 19152 Oral Surgeon Philadelphia<br />

Tran David 070972 A+ Oral Surgery Specialty Care PC 8355 Loretto Ave, Suite 104 Philadelphia PA 19152 Oral Surgeon Philadelphia<br />

Bandelac Georges 070943 A+ Periodontic Specialty Care PC 8001 Roosevelt Blvd, Suite 503 Philadelphia PA 19152 Periodontist Philadelphia<br />

Bandelac Georges 070942 A+ Periodontic Specialty Care PC 8355 Loretto Ave, Suite 104 Philadelphia PA 19152 Periodontist Philadelphia<br />

Bandelac Georges 070951 A+ Periodontic Specialty Care PC 8539 Bustleton Ave Philadelphia PA 19152 Periodontist Philadelphia<br />

Evans Marianna 070943 A+ Periodontic Specialty Care PC 8001 Roosevelt Blvd, Suite 503 Philadelphia PA 19152 Periodontist Philadelphia<br />

Evans Marianna 070942 A+ Periodontic Specialty Care PC 8355 Loretto Ave, Suite 104 Philadelphia PA 19152 Periodontist Philadelphia<br />

Evans Marianna 070951 A+ Periodontic Specialty Care PC 8539 Bustleton Ave Philadelphia PA 19152 Periodontist Philadelphia<br />

Charkas Ahmad 070933 Allied Orthodontics PC 8355 Loretto Ave, Suite 104 Philadelphia PA 19152 Orthodontist Philadelphia<br />

* Indicates dentist that is accepting current patients only.<br />

All <strong>Select</strong> <strong>Plan</strong> Dentists Page 39<br />

1 Same as a DHMO with fixed member copayments, no annual maximum dollar limits, no waiting periods, no deductibles, no pre-authorization paperwork or pre-treatment estimates and no<br />

claim forms or proof of loss (except in the case of out-of-area emergencies). Member must enroll with a General Dentist. Fac ID is used to indicate which facility a member chooses.


SELECT PLAN 1 DENTIST DIRECTORY<br />

Dentists listed are under contract as of 10/1/12<br />

Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />

Evans Marianna 070933 Allied Orthodontics PC 8355 Loretto Ave, Suite 104 Philadelphia PA 19152 Orthodontist Philadelphia<br />

Podray Brad 070933 Allied Orthodontics PC 8355 Loretto Ave, Suite 104 Philadelphia PA 19152 Orthodontist Philadelphia<br />

Pruzansky Dawn 070933 Allied Orthodontics PC 8355 Loretto Ave, Suite 104 Philadelphia PA 19152 Orthodontist Philadelphia<br />

Kondratyeva Natalya 001183 Magic <strong>Dental</strong> Systems 8253 Bustleton Ave. Philadelphia PA 19152 General <strong>Provider</strong> Philadelphia<br />

Rybak Marina 001183 Magic <strong>Dental</strong> Systems 8253 Bustleton Ave. Philadelphia PA 19152 General <strong>Provider</strong> Philadelphia<br />

Agrawal Avanti 068500 A 1 Family <strong>Dental</strong> Care PC 12301 Academy Rd, Suite 201-202 Philadelphia PA 19154 General <strong>Provider</strong> Philadelphia<br />

Derosa Daniel 068500 A 1 Family <strong>Dental</strong> Care PC 12301 Academy Rd, Suite 201-202 Philadelphia PA 19154 General <strong>Provider</strong> Philadelphia<br />

Desai Kaushal 068500 A 1 Family <strong>Dental</strong> Care PC 12301 Academy Rd, Suite 201-202 Philadelphia PA 19154 General <strong>Provider</strong> Philadelphia<br />

Gombar Anna 068500 A 1 Family <strong>Dental</strong> Care PC 12301 Academy Rd, Suite 201-202 Philadelphia PA 19154 General <strong>Provider</strong> Philadelphia<br />

Hoang Mark 068500 A 1 Family <strong>Dental</strong> Care PC 12301 Academy Rd, Suite 201-202 Philadelphia PA 19154 General <strong>Provider</strong> Philadelphia<br />

Hwang Sookie 068500 A 1 Family <strong>Dental</strong> Care PC 12301 Academy Rd, Suite 201-202 Philadelphia PA 19154 General <strong>Provider</strong> Philadelphia<br />

Kopp Anatoliy 068500 A 1 Family <strong>Dental</strong> Care PC 12301 Academy Rd, Suite 201-202 Philadelphia PA 19154 General <strong>Provider</strong> Philadelphia<br />

Purtuc Cynthia 068500 A 1 Family <strong>Dental</strong> Care PC 12301 Academy Rd, Suite 201-202 Philadelphia PA 19154 General <strong>Provider</strong> Philadelphia<br />

Savani Bhaskar 068500 A 1 Family <strong>Dental</strong> Care PC 12301 Academy Rd, Suite 201-202 Philadelphia PA 19154 General <strong>Provider</strong> Philadelphia<br />

Savani Bhumi 068500 A 1 Family <strong>Dental</strong> Care PC 12301 Academy Rd, Suite 201-202 Philadelphia PA 19154 General <strong>Provider</strong> Philadelphia<br />

Savani Niranjan 068500 A 1 Family <strong>Dental</strong> Care PC 12301 Academy Rd, Suite 201-202 Philadelphia PA 19154 General <strong>Provider</strong> Philadelphia<br />

Thoma Fjoralba 068500 A 1 Family <strong>Dental</strong> Care PC 12301 Academy Rd, Suite 201-202 Philadelphia PA 19154 General <strong>Provider</strong> Philadelphia<br />

Todd Meredith 068500 A 1 Family <strong>Dental</strong> Care PC 12301 Academy Rd, Suite 201-202 Philadelphia PA 19154 General <strong>Provider</strong> Philadelphia<br />

Paul Prolay 050726 Franklin Mills Mall <strong>Dental</strong> 1120 Franklin Mills Cir Philadelphia PA 19154 General <strong>Provider</strong> Philadelphia<br />

Shah Shreyas 050726 Franklin Mills Mall <strong>Dental</strong> 1120 Franklin Mills Cir Philadelphia PA 19154 General <strong>Provider</strong> Philadelphia<br />

Frankel Harvey 001553 Harvey Frankel, D.M.D. 614 S. Franklin Avenue Somerset PA 15501 Pedodontist Somerset<br />

Bott Robert 001228 Robert P. Bott, D.M.D. The Professional Bld, Main Street Avella PA 15312 General <strong>Provider</strong> Washington<br />

Pasqual Harry 001250 Pasqual Associates 3001 Waterdam Plaza Dr. Canonsburg PA 15317 Oral Surgeon Washington<br />

Adams William 001073 Katsur <strong>Dental</strong> & Orthodontics 661 McKean Avenue Donora PA 15033 General <strong>Provider</strong> Washington<br />

Affolter John 001073 Katsur <strong>Dental</strong> & Orthodontics 661 McKean Avenue Donora PA 15033 General <strong>Provider</strong> Washington<br />

Alagirisamy Kiruthika 001073 Katsur <strong>Dental</strong> & Orthodontics 661 McKean Avenue Donora PA 15033 General <strong>Provider</strong> Washington<br />

Carozza Roselyn 001073 Katsur <strong>Dental</strong> & Orthodontics 661 McKean Avenue Donora PA 15033 General <strong>Provider</strong> Washington<br />

Cohen Ira 001073 Katsur <strong>Dental</strong> & Orthodontics 661 McKean Avenue Donora PA 15033 General <strong>Provider</strong> Washington<br />

Dahar Nicholas 001073 Katsur <strong>Dental</strong> & Orthodontics 661 McKean Avenue Donora PA 15033 Orthodontist Washington<br />

Damich Louis 001073 Katsur <strong>Dental</strong> & Orthodontics 661 McKean Avenue Donora PA 15033 General <strong>Provider</strong> Washington<br />

Ghaffari Catherine 001073 Katsur <strong>Dental</strong> & Orthodontics 661 McKean Avenue Donora PA 15033 General <strong>Provider</strong> Washington<br />

Ghajarnia M. Reza 001073 Katsur <strong>Dental</strong> & Orthodontics 661 McKean Avenue Donora PA 15033 Orthodontist Washington<br />

Gillen Steve 001073 Katsur <strong>Dental</strong> & Orthodontics 661 McKean Avenue Donora PA 15033 General <strong>Provider</strong> Washington<br />

Iszkula Steven 001073 Katsur <strong>Dental</strong> & Orthodontics 661 McKean Avenue Donora PA 15033 Orthodontist Washington<br />

Katsur James 001073 Katsur <strong>Dental</strong> & Orthodontics 661 McKean Avenue Donora PA 15033 General <strong>Provider</strong> Washington<br />

Khurana Leena 001073 Katsur <strong>Dental</strong> & Orthodontics 661 McKean Avenue Donora PA 15033 General <strong>Provider</strong> Washington<br />

Kier Calvin 001073 Katsur <strong>Dental</strong> & Orthodontics 661 McKean Avenue Donora PA 15033 General <strong>Provider</strong> Washington<br />

King David 001073 Katsur <strong>Dental</strong> & Orthodontics 661 McKean Avenue Donora PA 15033 Orthodontist Washington<br />

Kolla Siva 001073 Katsur <strong>Dental</strong> & Orthodontics 661 McKean Avenue Donora PA 15033 General <strong>Provider</strong> Washington<br />

Lewis Howell 001073 Katsur <strong>Dental</strong> & Orthodontics 661 McKean Avenue Donora PA 15033 Orthodontist Washington<br />

Miller Van 001073 Katsur <strong>Dental</strong> & Orthodontics 661 McKean Avenue Donora PA 15033 Orthodontist Washington<br />

Pryor Leroy 001073 Katsur <strong>Dental</strong> & Orthodontics 661 McKean Avenue Donora PA 15033 General <strong>Provider</strong> Washington<br />

Rinchuse Dara 001073 Katsur <strong>Dental</strong> & Orthodontics 661 McKean Avenue Donora PA 15033 Orthodontist Washington<br />

Schmidt Alan 001073 Katsur <strong>Dental</strong> & Orthodontics 661 McKean Avenue Donora PA 15033 General <strong>Provider</strong> Washington<br />

Smiga Ingrid 001073 Katsur <strong>Dental</strong> & Orthodontics 661 McKean Avenue Donora PA 15033 General <strong>Provider</strong> Washington<br />

Stein Mark 001073 Katsur <strong>Dental</strong> & Orthodontics 661 McKean Avenue Donora PA 15033 General <strong>Provider</strong> Washington<br />

Tinnemeyer Anjuli 001073 Katsur <strong>Dental</strong> & Orthodontics 661 McKean Avenue Donora PA 15033 General <strong>Provider</strong> Washington<br />

Zalakar Frank 001073 Katsur <strong>Dental</strong> & Orthodontics 661 McKean Avenue Donora PA 15033 General <strong>Provider</strong> Washington<br />

Dandashi Moutaz 050689 Katsur <strong>Dental</strong> & Orthodontics Specialists 661 McKean Ave Donora PA 15033 Pedodontist Washington<br />

Hertzler L Gregory 050689 Katsur <strong>Dental</strong> & Orthodontics Specialists 661 McKean Ave Donora PA 15033 Oral Surgeon Washington<br />

Kelly Derek 050689 Katsur <strong>Dental</strong> & Orthodontics Specialists 661 McKean Ave Donora PA 15033 Oral Surgeon Washington<br />

Kier Gregory 050689 Katsur <strong>Dental</strong> & Orthodontics Specialists 661 McKean Ave Donora PA 15033 Periodontist Washington<br />

Monti Richard 050689 Katsur <strong>Dental</strong> & Orthodontics Specialists 661 McKean Ave Donora PA 15033 Oral Surgeon Washington<br />

Manalo Arsenio 001491 McMurray <strong>Dental</strong> 4143 Washington Road, Waterdam Centre McMurray PA 15317 General <strong>Provider</strong> Washington<br />

Pruce Robert 001442 Robert L. Pruce, D.M.D. 608 East McMurray Road McMurray PA 15317 General <strong>Provider</strong> Washington<br />

* Roth Gilbert 001632 Waterdam <strong>Dental</strong> Associates, P.C. 161 Waterdam Rd., Suite 250 McMurray PA 15317 General <strong>Provider</strong> Washington<br />

Roth Gilbert 001633 Waterdam <strong>Dental</strong> Associates, P.C. 2 Mill Street Millsboro PA 15348 General <strong>Provider</strong> Washington<br />

Rodriguez Randall 001606 Randall Rodriguez, D.M.D. 173 W Main St Monongahela PA 15063 General <strong>Provider</strong> Washington<br />

Adams William 000984 Katsur <strong>Dental</strong> & Orthodontics Rte. 19, North Gate Plaze Washington PA 15301 General <strong>Provider</strong> Washington<br />

Affolter John 000984 Katsur <strong>Dental</strong> & Orthodontics Rte. 19, North Gate Plaze Washington PA 15301 General <strong>Provider</strong> Washington<br />

Alagirisamy Kiruthika 000984 Katsur <strong>Dental</strong> & Orthodontics Rte. 19, North Gate Plaze Washington PA 15301 General <strong>Provider</strong> Washington<br />

Carozza Roselyn 000984 Katsur <strong>Dental</strong> & Orthodontics Rte. 19, North Gate Plaze Washington PA 15301 General <strong>Provider</strong> Washington<br />

Cohen Ira 000984 Katsur <strong>Dental</strong> & Orthodontics Rte. 19, North Gate Plaze Washington PA 15301 General <strong>Provider</strong> Washington<br />

Dahar Nicholas 000984 Katsur <strong>Dental</strong> & Orthodontics Rte. 19, North Gate Plaze Washington PA 15301 Orthodontist Washington<br />

Damich Louis 000984 Katsur <strong>Dental</strong> & Orthodontics Rte. 19, North Gate Plaze Washington PA 15301 General <strong>Provider</strong> Washington<br />

Ghaffari Catherine 000984 Katsur <strong>Dental</strong> & Orthodontics Rte. 19, North Gate Plaze Washington PA 15301 General <strong>Provider</strong> Washington<br />

* Indicates dentist that is accepting current patients only.<br />

All <strong>Select</strong> <strong>Plan</strong> Dentists Page 40<br />

1 Same as a DHMO with fixed member copayments, no annual maximum dollar limits, no waiting periods, no deductibles, no pre-authorization paperwork or pre-treatment estimates and no<br />

claim forms or proof of loss (except in the case of out-of-area emergencies). Member must enroll with a General Dentist. Fac ID is used to indicate which facility a member chooses.


SELECT PLAN 1 DENTIST DIRECTORY<br />

Dentists listed are under contract as of 10/1/12<br />

Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />

Ghajarnia M. Reza 000984 Katsur <strong>Dental</strong> & Orthodontics Rte. 19, North Gate Plaze Washington PA 15301 Orthodontist Washington<br />

Gillen Steve 000984 Katsur <strong>Dental</strong> & Orthodontics Rte. 19, North Gate Plaze Washington PA 15301 General <strong>Provider</strong> Washington<br />

Iszkula Steven 000984 Katsur <strong>Dental</strong> & Orthodontics Rte. 19, North Gate Plaze Washington PA 15301 Orthodontist Washington<br />

Katsur James 000984 Katsur <strong>Dental</strong> & Orthodontics Rte. 19, North Gate Plaze Washington PA 15301 General <strong>Provider</strong> Washington<br />

Khurana Leena 000984 Katsur <strong>Dental</strong> & Orthodontics Rte. 19, North Gate Plaze Washington PA 15301 General <strong>Provider</strong> Washington<br />

Kier Calvin 000984 Katsur <strong>Dental</strong> & Orthodontics Rte. 19, North Gate Plaze Washington PA 15301 General <strong>Provider</strong> Washington<br />

King David 000984 Katsur <strong>Dental</strong> & Orthodontics Rte. 19, North Gate Plaze Washington PA 15301 Orthodontist Washington<br />

Kolla Siva 000984 Katsur <strong>Dental</strong> & Orthodontics Rte. 19, North Gate Plaze Washington PA 15301 General <strong>Provider</strong> Washington<br />

Lewis Howell 000984 Katsur <strong>Dental</strong> & Orthodontics Rte. 19, North Gate Plaze Washington PA 15301 Orthodontist Washington<br />

Miller Van 000984 Katsur <strong>Dental</strong> & Orthodontics Rte. 19, North Gate Plaze Washington PA 15301 Orthodontist Washington<br />

Pryor Leroy 000984 Katsur <strong>Dental</strong> & Orthodontics Rte. 19, North Gate Plaze Washington PA 15301 General <strong>Provider</strong> Washington<br />

Rinchuse Dara 000984 Katsur <strong>Dental</strong> & Orthodontics Rte. 19, North Gate Plaze Washington PA 15301 Orthodontist Washington<br />

Schmidt Alan 000984 Katsur <strong>Dental</strong> & Orthodontics Rte. 19, North Gate Plaze Washington PA 15301 General <strong>Provider</strong> Washington<br />

Smiga Ingrid 000984 Katsur <strong>Dental</strong> & Orthodontics Rte. 19, North Gate Plaze Washington PA 15301 General <strong>Provider</strong> Washington<br />

Stein Mark 000984 Katsur <strong>Dental</strong> & Orthodontics Rte. 19, North Gate Plaze Washington PA 15301 General <strong>Provider</strong> Washington<br />

Zalakar Frank 000984 Katsur <strong>Dental</strong> & Orthodontics Rte. 19, North Gate Plaze Washington PA 15301 General <strong>Provider</strong> Washington<br />

Dandashi Moutaz 050695 Katsur <strong>Dental</strong> & Orthodontics Specialists Northgate Plaza, Route 19 Washington PA 15301 Pedodontist Washington<br />

Hertzler L Gregory 050695 Katsur <strong>Dental</strong> & Orthodontics Specialists Northgate Plaza, Route 19 Washington PA 15301 Oral Surgeon Washington<br />

Kelly Derek 050695 Katsur <strong>Dental</strong> & Orthodontics Specialists Northgate Plaza, Route 19 Washington PA 15301 Oral Surgeon Washington<br />

Kier Gregory 050695 Katsur <strong>Dental</strong> & Orthodontics Specialists Northgate Plaza, Route 19 Washington PA 15301 Periodontist Washington<br />

Monti Richard 050695 Katsur <strong>Dental</strong> & Orthodontics Specialists Northgate Plaza, Route 19 Washington PA 15301 Oral Surgeon Washington<br />

Lucyk-Pavasko Lauren 001607 David H.J. Pavasko, D.M.D. 4810 Old William Penn Highway, Suite 4 Export PA 15632 General <strong>Provider</strong> Westmoreland<br />

Pavasko David 001607 David H.J. Pavasko, D.M.D. 4810 Old William Penn Highway, Suite 4 Export PA 15632 General <strong>Provider</strong> Westmoreland<br />

Nista Mark 068481 Nista Family <strong>Dental</strong> Center PC 105 Pfeffer Rd, Suite 2 Export PA 15632 General <strong>Provider</strong> Westmoreland<br />

Check Jennifer 040243 Aspen <strong>Dental</strong> 6088 Route 30 Greensburg PA 15601 General <strong>Provider</strong> Westmoreland<br />

Ciarallo Robert 040243 Aspen <strong>Dental</strong> 6088 Route 30 Greensburg PA 15601 Oral Surgeon Westmoreland<br />

Cignetti Scott 040243 Aspen <strong>Dental</strong> 6088 Route 30 Greensburg PA 15601 General <strong>Provider</strong> Westmoreland<br />

Fazio John 040243 Aspen <strong>Dental</strong> 6088 Route 30 Greensburg PA 15601 General <strong>Provider</strong> Westmoreland<br />

Ferguson III William 040243 Aspen <strong>Dental</strong> 6088 Route 30 Greensburg PA 15601 General <strong>Provider</strong> Westmoreland<br />

Grinberg Anna 040243 Aspen <strong>Dental</strong> 6088 Route 30 Greensburg PA 15601 General <strong>Provider</strong> Westmoreland<br />

Khalil Mirette 040243 Aspen <strong>Dental</strong> 6088 Route 30 Greensburg PA 15601 General <strong>Provider</strong> Westmoreland<br />

Malone Matthew 040243 Aspen <strong>Dental</strong> 6088 Route 30 Greensburg PA 15601 General <strong>Provider</strong> Westmoreland<br />

McCann Eve 040243 Aspen <strong>Dental</strong> 6088 Route 30 Greensburg PA 15601 General <strong>Provider</strong> Westmoreland<br />

McClain Kelly 040243 Aspen <strong>Dental</strong> 6088 Route 30 Greensburg PA 15601 General <strong>Provider</strong> Westmoreland<br />

Monios George 040243 Aspen <strong>Dental</strong> 6088 Route 30 Greensburg PA 15601 General <strong>Provider</strong> Westmoreland<br />

Raja Nabila 040243 Aspen <strong>Dental</strong> 6088 Route 30 Greensburg PA 15601 General <strong>Provider</strong> Westmoreland<br />

Somers Mitchell 040243 Aspen <strong>Dental</strong> 6088 Route 30 Greensburg PA 15601 General <strong>Provider</strong> Westmoreland<br />

Tam Dominic 040243 Aspen <strong>Dental</strong> 6088 Route 30 Greensburg PA 15601 General <strong>Provider</strong> Westmoreland<br />

Matthews Bruce 001623 Bruce A. Matthews, D.M.D., M.D.S. 1225 S. Main Street, Wellington Square, #300 Greensburg PA 15601 Orthodontist Westmoreland<br />

* Kraisinger Paul 001667 Complete Family Dentistry 80 Huff Avenue, #1 Greensburg PA 15601 General <strong>Provider</strong> Westmoreland<br />

Haggard Kai Ying 002834 Dent-Al Smiles 29 N. Main St, Suite 206 Greensburg PA 15601 General <strong>Provider</strong> Westmoreland<br />

Adams William 002227 Katsur <strong>Dental</strong> & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 General <strong>Provider</strong> Westmoreland<br />

Affolter John 002227 Katsur <strong>Dental</strong> & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 General <strong>Provider</strong> Westmoreland<br />

Alagirisamy Kiruthika 002227 Katsur <strong>Dental</strong> & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 General <strong>Provider</strong> Westmoreland<br />

Carozza Roselyn 002227 Katsur <strong>Dental</strong> & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 General <strong>Provider</strong> Westmoreland<br />

Cohen Ira 002227 Katsur <strong>Dental</strong> & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 General <strong>Provider</strong> Westmoreland<br />

Dahar Nicholas 002227 Katsur <strong>Dental</strong> & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 Orthodontist Westmoreland<br />

Damich Louis 002227 Katsur <strong>Dental</strong> & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 General <strong>Provider</strong> Westmoreland<br />

Ghaffari Catherine 002227 Katsur <strong>Dental</strong> & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 General <strong>Provider</strong> Westmoreland<br />

Ghajarnia M. Reza 002227 Katsur <strong>Dental</strong> & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 Orthodontist Westmoreland<br />

Gillen Steve 002227 Katsur <strong>Dental</strong> & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 General <strong>Provider</strong> Westmoreland<br />

Iszkula Steven 002227 Katsur <strong>Dental</strong> & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 Orthodontist Westmoreland<br />

Katsur James 002227 Katsur <strong>Dental</strong> & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 General <strong>Provider</strong> Westmoreland<br />

Khurana Leena 002227 Katsur <strong>Dental</strong> & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 General <strong>Provider</strong> Westmoreland<br />

Kier Calvin 002227 Katsur <strong>Dental</strong> & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 General <strong>Provider</strong> Westmoreland<br />

King David 002227 Katsur <strong>Dental</strong> & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 Orthodontist Westmoreland<br />

Kolla Siva 002227 Katsur <strong>Dental</strong> & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 General <strong>Provider</strong> Westmoreland<br />

Lewis Howell 002227 Katsur <strong>Dental</strong> & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 Orthodontist Westmoreland<br />

Miller Van 002227 Katsur <strong>Dental</strong> & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 Orthodontist Westmoreland<br />

Pryor Leroy 002227 Katsur <strong>Dental</strong> & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 General <strong>Provider</strong> Westmoreland<br />

Rinchuse Dara 002227 Katsur <strong>Dental</strong> & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 Orthodontist Westmoreland<br />

Schmidt Alan 002227 Katsur <strong>Dental</strong> & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 General <strong>Provider</strong> Westmoreland<br />

Smiga Ingrid 002227 Katsur <strong>Dental</strong> & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 General <strong>Provider</strong> Westmoreland<br />

Stein Mark 002227 Katsur <strong>Dental</strong> & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 General <strong>Provider</strong> Westmoreland<br />

Tinnemeyer Anjuli 002227 Katsur <strong>Dental</strong> & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 General <strong>Provider</strong> Westmoreland<br />

Zalakar Frank 002227 Katsur <strong>Dental</strong> & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 General <strong>Provider</strong> Westmoreland<br />

* Indicates dentist that is accepting current patients only.<br />

All <strong>Select</strong> <strong>Plan</strong> Dentists Page 41<br />

1 Same as a DHMO with fixed member copayments, no annual maximum dollar limits, no waiting periods, no deductibles, no pre-authorization paperwork or pre-treatment estimates and no<br />

claim forms or proof of loss (except in the case of out-of-area emergencies). Member must enroll with a General Dentist. Fac ID is used to indicate which facility a member chooses.


SELECT PLAN 1 DENTIST DIRECTORY<br />

Dentists listed are under contract as of 10/1/12<br />

Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />

Dandashi Moutaz 050699 Katsur <strong>Dental</strong> & Orthodontics Specialists 801 Greengate Rd, Suite 310 Greensburg PA 15601 Pedodontist Westmoreland<br />

Hertzler L Gregory 050699 Katsur <strong>Dental</strong> & Orthodontics Specialists 801 Greengate Rd, Suite 310 Greensburg PA 15601 Oral Surgeon Westmoreland<br />

Kelly Derek 050699 Katsur <strong>Dental</strong> & Orthodontics Specialists 801 Greengate Rd, Suite 310 Greensburg PA 15601 Oral Surgeon Westmoreland<br />

Kier Gregory 050699 Katsur <strong>Dental</strong> & Orthodontics Specialists 801 Greengate Rd, Suite 310 Greensburg PA 15601 Periodontist Westmoreland<br />

Monti Richard 050699 Katsur <strong>Dental</strong> & Orthodontics Specialists 801 Greengate Rd, Suite 310 Greensburg PA 15601 Oral Surgeon Westmoreland<br />

Vince Thomas 001536 Thomas S. Vince, D.M.D. & Associates 985 Towne Square Drive, Suite 100 Greensburg PA 15601 General <strong>Provider</strong> Westmoreland<br />

Purvis Kenneth 001853 Kenneth G. Purvis D.D.S. Ltd. 1010 Jefferson Street Latrobe PA 15650 Orthodontist Westmoreland<br />

Matthews Bruce 001624 Bruce A. Matthews, D.M.D., M.D.S. 123 W. Main Street, Suite 1 Ligonier PA 15658 Orthodontist Westmoreland<br />

Purvis Kenneth 001856 Kenneth G. Purvis, D.D.S. Ltd. 112 South Walnut Ligonier PA 15658 Orthodontist Westmoreland<br />

Adams William 000989 Katsur <strong>Dental</strong> & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 General <strong>Provider</strong> Westmoreland<br />

Affolter John 000989 Katsur <strong>Dental</strong> & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 General <strong>Provider</strong> Westmoreland<br />

Alagirisamy Kiruthika 000989 Katsur <strong>Dental</strong> & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 General <strong>Provider</strong> Westmoreland<br />

Carozza Roselyn 000989 Katsur <strong>Dental</strong> & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 General <strong>Provider</strong> Westmoreland<br />

Cohen Ira 000989 Katsur <strong>Dental</strong> & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 General <strong>Provider</strong> Westmoreland<br />

Dahar Nicholas 000989 Katsur <strong>Dental</strong> & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 Orthodontist Westmoreland<br />

Damich Louis 000989 Katsur <strong>Dental</strong> & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 General <strong>Provider</strong> Westmoreland<br />

Ghaffari Catherine 000989 Katsur <strong>Dental</strong> & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 General <strong>Provider</strong> Westmoreland<br />

Ghajarnia M. Reza 000989 Katsur <strong>Dental</strong> & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 Orthodontist Westmoreland<br />

Gillen Steve 000989 Katsur <strong>Dental</strong> & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 General <strong>Provider</strong> Westmoreland<br />

Iszkula Steven 000989 Katsur <strong>Dental</strong> & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 Orthodontist Westmoreland<br />

Katsur James 000989 Katsur <strong>Dental</strong> & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 General <strong>Provider</strong> Westmoreland<br />

Khurana Leena 000989 Katsur <strong>Dental</strong> & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 General <strong>Provider</strong> Westmoreland<br />

Kier Calvin 000989 Katsur <strong>Dental</strong> & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 General <strong>Provider</strong> Westmoreland<br />

King David 000989 Katsur <strong>Dental</strong> & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 Orthodontist Westmoreland<br />

Kolla Siva 000989 Katsur <strong>Dental</strong> & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 General <strong>Provider</strong> Westmoreland<br />

Lewis Howell 000989 Katsur <strong>Dental</strong> & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 Orthodontist Westmoreland<br />

Miller Van 000989 Katsur <strong>Dental</strong> & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 Orthodontist Westmoreland<br />

Pryor Leroy 000989 Katsur <strong>Dental</strong> & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 General <strong>Provider</strong> Westmoreland<br />

Rinchuse Dara 000989 Katsur <strong>Dental</strong> & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 Orthodontist Westmoreland<br />

Schmidt Alan 000989 Katsur <strong>Dental</strong> & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 General <strong>Provider</strong> Westmoreland<br />

Smiga Ingrid 000989 Katsur <strong>Dental</strong> & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 General <strong>Provider</strong> Westmoreland<br />

Stein Mark 000989 Katsur <strong>Dental</strong> & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 General <strong>Provider</strong> Westmoreland<br />

Tinnemeyer Anjuli 000989 Katsur <strong>Dental</strong> & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 General <strong>Provider</strong> Westmoreland<br />

Zalakar Frank 000989 Katsur <strong>Dental</strong> & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 General <strong>Provider</strong> Westmoreland<br />

Dandashi Moutaz 050693 Katsur <strong>Dental</strong> & Orthodontics Specialists 129 Hillcrest Shopping Center Lower Burrell PA 15068 Pedodontist Westmoreland<br />

Hertzler L Gregory 050693 Katsur <strong>Dental</strong> & Orthodontics Specialists 129 Hillcrest Shopping Center Lower Burrell PA 15068 Oral Surgeon Westmoreland<br />

Kelly Derek 050693 Katsur <strong>Dental</strong> & Orthodontics Specialists 129 Hillcrest Shopping Center Lower Burrell PA 15068 Oral Surgeon Westmoreland<br />

Kier Gregory 050693 Katsur <strong>Dental</strong> & Orthodontics Specialists 129 Hillcrest Shopping Center Lower Burrell PA 15068 Periodontist Westmoreland<br />

Monti Richard 050693 Katsur <strong>Dental</strong> & Orthodontics Specialists 129 Hillcrest Shopping Center Lower Burrell PA 15068 Oral Surgeon Westmoreland<br />

Kreashko Robert 002570 Kreashko Orthodontics 2755 Leechburg Rd. Lower Burrell PA 15068 Orthodontist Westmoreland<br />

Seitz Raymond 002330 Raymond C. Seitz, D.M.D. 2797 Leechburg Road Lower Burrell PA 15068 General <strong>Provider</strong> Westmoreland<br />

Al Rasheed Manuela 001898 Manuela Al Rasheed, D.M.D. 828 W. Main Street Mount Pleasant PA 15666 General <strong>Provider</strong> Westmoreland<br />

Santora Donald 001608 Mt Pleasant <strong>Dental</strong> Associates PC 770 Route 819 South, P.O. Box 954 Mount Pleasant PA 15666 General <strong>Provider</strong> Westmoreland<br />

Loyacona Gerald 001840 Gerald Loyacona, D.M.D. 4771 Old William Penn Hwy. Murrysville PA 15668 Orthodontist Westmoreland<br />

Balasubramaniam Ravi 001492 Laurel Highlands Family Dentistry 4057 Old William Penn Murrysville PA 15668 General <strong>Provider</strong> Westmoreland<br />

Matthews Bruce 001625 Bruce A. Matthews, D.M.D., M.D.S. 1061 Main Street, Banco Bus Park, Suite 2CI North Huntingdon PA 15642 Orthodontist Westmoreland<br />

Babameto Blendi 051062 Aspen <strong>Dental</strong> 409 Eisenhower Dr Hanover PA 17331 Oral Surgeon York<br />

Desai Jagruti 051062 Aspen <strong>Dental</strong> 409 Eisenhower Dr Hanover PA 17331 General <strong>Provider</strong> York<br />

Kaur Kamaljit 051062 Aspen <strong>Dental</strong> 409 Eisenhower Dr Hanover PA 17331 General <strong>Provider</strong> York<br />

Kuleva Juliana 051062 Aspen <strong>Dental</strong> 409 Eisenhower Dr Hanover PA 17331 General <strong>Provider</strong> York<br />

Popernack John 051062 Aspen <strong>Dental</strong> 409 Eisenhower Dr Hanover PA 17331 General <strong>Provider</strong> York<br />

Talati Ankit 051062 Aspen <strong>Dental</strong> 409 Eisenhower Dr Hanover PA 17331 General <strong>Provider</strong> York<br />

Withanachchi Janatha 051062 Aspen <strong>Dental</strong> 409 Eisenhower Dr Hanover PA 17331 Endodontist York<br />

Babameto Blendi 037962 Aspen <strong>Dental</strong> Associates of NE PA PC 2803 Concord Rd York PA 17402 Oral Surgeon York<br />

Botros Samuel 037962 Aspen <strong>Dental</strong> Associates of NE PA PC 2803 Concord Rd York PA 17402 General <strong>Provider</strong> York<br />

Chandalada Agastayya 037962 Aspen <strong>Dental</strong> Associates of NE PA PC 2803 Concord Rd York PA 17402 General <strong>Provider</strong> York<br />

Hu Yu Hui 037962 Aspen <strong>Dental</strong> Associates of NE PA PC 2803 Concord Rd York PA 17402 General <strong>Provider</strong> York<br />

Pham Thuy 037962 Aspen <strong>Dental</strong> Associates of NE PA PC 2803 Concord Rd York PA 17402 General <strong>Provider</strong> York<br />

Tran Joshua 037962 Aspen <strong>Dental</strong> Associates of NE PA PC 2803 Concord Rd York PA 17402 General <strong>Provider</strong> York<br />

Williams Christopher 037962 Aspen <strong>Dental</strong> Associates of NE PA PC 2803 Concord Rd York PA 17402 General <strong>Provider</strong> York<br />

Withanachchi Janatha 037962 Aspen <strong>Dental</strong> Associates of NE PA PC 2803 Concord Rd York PA 17402 Endodontist York<br />

Babameto Blendi 033834 Aspen <strong>Dental</strong> Associates of NE PA PC 1101 Carlisle Rd. York PA 17404 Oral Surgeon York<br />

Botros Samuel 033834 Aspen <strong>Dental</strong> Associates of NE PA PC 1101 Carlisle Rd. York PA 17404 General <strong>Provider</strong> York<br />

Chandalada Agastayya 033834 Aspen <strong>Dental</strong> Associates of NE PA PC 1101 Carlisle Rd. York PA 17404 General <strong>Provider</strong> York<br />

Chaudhry Ahmad 033834 Aspen <strong>Dental</strong> Associates of NE PA PC 1101 Carlisle Rd. York PA 17404 General <strong>Provider</strong> York<br />

Hamati Isam 033834 Aspen <strong>Dental</strong> Associates of NE PA PC 1101 Carlisle Rd. York PA 17404 General <strong>Provider</strong> York<br />

* Indicates dentist that is accepting current patients only.<br />

All <strong>Select</strong> <strong>Plan</strong> Dentists Page 42<br />

1 Same as a DHMO with fixed member copayments, no annual maximum dollar limits, no waiting periods, no deductibles, no pre-authorization paperwork or pre-treatment estimates and no<br />

claim forms or proof of loss (except in the case of out-of-area emergencies). Member must enroll with a General Dentist. Fac ID is used to indicate which facility a member chooses.


SELECT PLAN 1 DENTIST DIRECTORY<br />

Dentists listed are under contract as of 10/1/12<br />

Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />

Hu Yu Hui 033834 Aspen <strong>Dental</strong> Associates of NE PA PC 1101 Carlisle Rd. York PA 17404 General <strong>Provider</strong> York<br />

Pham Thuy 033834 Aspen <strong>Dental</strong> Associates of NE PA PC 1101 Carlisle Rd. York PA 17404 General <strong>Provider</strong> York<br />

Tran Joshua 033834 Aspen <strong>Dental</strong> Associates of NE PA PC 1101 Carlisle Rd. York PA 17404 General <strong>Provider</strong> York<br />

Williams Christopher 033834 Aspen <strong>Dental</strong> Associates of NE PA PC 1101 Carlisle Rd. York PA 17404 General <strong>Provider</strong> York<br />

Withanachchi Janatha 033834 Aspen <strong>Dental</strong> Associates of NE PA PC 1101 Carlisle Rd. York PA 17404 Endodontist York<br />

Byrnside Valerie 051075 Scott R Goodove DDS PLC 25529 E Main St Onley VA 23418 Oral Surgeon Accomack<br />

Goodove Scott 051075 Scott R Goodove DDS PLC 25529 E Main St Onley VA 23418 Oral Surgeon Accomack<br />

Harris Christopher 051075 Scott R Goodove DDS PLC 25529 E Main St Onley VA 23418 Oral Surgeon Accomack<br />

Kotler Lawrence 000224 Lawrence M. Kotler, D.D.S., MS. 3543 W. Braddock Rd., E-1 Alexandria VA 22302 Endodontist Alexandria City<br />

Phan Phuong 002274 Phuong Phan D.MD PC 1225 Martha Custis Drive, #C-6 Alexandria VA 22302 General <strong>Provider</strong> Alexandria City<br />

Alayssami Mazin 000144 Bright Now <strong>Dental</strong> 5249 Duke Street, Suite 210 Alexandria VA 22304 General <strong>Provider</strong> Alexandria City<br />

Khattak Farida 000144 Bright Now <strong>Dental</strong> 5249 Duke Street, Suite 210 Alexandria VA 22304 General <strong>Provider</strong> Alexandria City<br />

Selenou-Tema Alain 000144 Bright Now <strong>Dental</strong> 5249 Duke Street, Suite 210 Alexandria VA 22304 General <strong>Provider</strong> Alexandria City<br />

Morgan David 080801 David M Morgan DDS MD PLC 101 S Whiting St, Suite 106 Alexandria VA 22304 Oral Surgeon Alexandria City<br />

Meza Fernando 037720 Fernando J. Meza, DMD, PLLC 4660 Kenmore Ave, 700 Alexandria VA 22304 Endodontist Alexandria City<br />

Russo Revand Jessica 037720 Fernando J. Meza, DMD, PLLC 4660 Kenmore Ave, 700 Alexandria VA 22304 Endodontist Alexandria City<br />

Tsui Nathan 000239 Nathan Tsui, D.D.S. 5249 Duke St., Suite 10 Alexandria VA 22304 General <strong>Provider</strong> Alexandria City<br />

Kwon Thomas 000342 Thomas S. Kwon, D.D.S. 4701 Kenmore Ave., Suite 122 Alexandria VA 22304 General <strong>Provider</strong> Alexandria City<br />

Traboulsi Georges 097168 Alexandria Smile Dentistry Specialists 5234 Dawes Ave Alexandria VA 22311 Periodontist Alexandria City<br />

Tolson Ronald 000215 Ronald E Tolson DDS 5246 Dawes Ave Alexandria VA 22311 General <strong>Provider</strong> Alexandria City<br />

Kermanshi Shiva 050340 Alexandria <strong>Dental</strong> Care PLLC 715 Pendleton St Alexandria VA 22314 Orthodontist Alexandria City<br />

Solemaninejad Homan 050340 Alexandria <strong>Dental</strong> Care PLLC 715 Pendleton St Alexandria VA 22314 General <strong>Provider</strong> Alexandria City<br />

Gasper Ronald 001660 Ronald S. Gasper, D.D.S., Ltd. 1454 Duke St, Suite 200 Alexandria VA 22314 Orthodontist Alexandria City<br />

Huynh Thuylinh 050343 Arlington Center For Dentistry Orthodontics 1050 N Highland St, 300-N Arlington VA 22201 Orthodontist Arlington<br />

Asher Kevin 037805 Arlington Center for Dentistry Specialists 1050 N Highland St, 300-N Arlington VA 22201 Oral Surgeon Arlington<br />

Colosi Ryan 037805 Arlington Center for Dentistry Specialists 1050 N Highland St, 300-N Arlington VA 22201 Pedodontist Arlington<br />

Gichana Roselyne 037805 Arlington Center for Dentistry Specialists 1050 N Highland St, 300-N Arlington VA 22201 Pedodontist Arlington<br />

Lan Steve 037805 Arlington Center for Dentistry Specialists 1050 N Highland St, 300-N Arlington VA 22201 Pedodontist Arlington<br />

Nguyen Phuong 037805 Arlington Center for Dentistry Specialists 1050 N Highland St, 300-N Arlington VA 22201 Oral Surgeon Arlington<br />

Park Nam 037805 Arlington Center for Dentistry Specialists 1050 N Highland St, 300-N Arlington VA 22201 Oral Surgeon Arlington<br />

Son Joseph 037805 Arlington Center for Dentistry Specialists 1050 N Highland St, 300-N Arlington VA 22201 Endodontist Arlington<br />

Shojaei Mariah 037689 Arlington Cosmetic <strong>Dental</strong> Group 1731 Clarendon Blvd Arlington VA 22201 Endodontist Arlington<br />

* Economides Mino 000939 Mino Economides, D.D.S. 1301 N. Highland Street Arlington VA 22201 General <strong>Provider</strong> Arlington<br />

* Lebo Carl 000233 Carl G Lebo DDS PC 3801 N. Fairfax Dr., Suite 72 Arlington VA 22203 General <strong>Provider</strong> Arlington<br />

Zadeh David 001664 Zadeh <strong>Dental</strong> Office 611 S. Carlin Springs Road, Suite 408 Arlington VA 22204 General <strong>Provider</strong> Arlington<br />

Patterson Travis 002109 Drs. Whiston, Patterson & Corcoran 2501 N. Glebe Road, Suite 203 Arlington VA 22207 Oral Surgeon Arlington<br />

Saleh Fadi 050933 Fadi Saleh DDS LLC 1911 N Fort Myer Drive, Suite 101 Arlington VA 22209 Orthodontist Arlington<br />

Mogharbel Tarek 037711 Mira <strong>Dental</strong> Care 1901 N Moore St, Suite 501 Arlington VA 22209 General <strong>Provider</strong> Arlington<br />

Boyce Darrell 002606 Darrell L. Boyce, D.D.S.,P.C. 1711 Parkview Dr. Chesapeake VA 23320 General <strong>Provider</strong> Chesapeake City<br />

* Abdelwahab Tamer 068512 Konikoff <strong>Dental</strong> Associates 1533 Volvo Pkwy Chesapeake VA 23320 General <strong>Provider</strong> Chesapeake City<br />

* Abdelwahab Tamer 050722 Konikoff <strong>Dental</strong> Associates 684 Battlefield Blvd Chesapeake VA 23320 General <strong>Provider</strong> Chesapeake City<br />

* Ansari Uzma 068512 Konikoff <strong>Dental</strong> Associates 1533 Volvo Pkwy Chesapeake VA 23320 General <strong>Provider</strong> Chesapeake City<br />

* Ansari Uzma 050722 Konikoff <strong>Dental</strong> Associates 684 Battlefield Blvd Chesapeake VA 23320 General <strong>Provider</strong> Chesapeake City<br />

* Berrada Sanae 068512 Konikoff <strong>Dental</strong> Associates 1533 Volvo Pkwy Chesapeake VA 23320 General <strong>Provider</strong> Chesapeake City<br />

* Berrada Sanae 050722 Konikoff <strong>Dental</strong> Associates 684 Battlefield Blvd Chesapeake VA 23320 General <strong>Provider</strong> Chesapeake City<br />

* Bozman Jenny 068512 Konikoff <strong>Dental</strong> Associates 1533 Volvo Pkwy Chesapeake VA 23320 General <strong>Provider</strong> Chesapeake City<br />

* Bozman Jenny 050722 Konikoff <strong>Dental</strong> Associates 684 Battlefield Blvd Chesapeake VA 23320 General <strong>Provider</strong> Chesapeake City<br />

* Chawla Seema 068512 Konikoff <strong>Dental</strong> Associates 1533 Volvo Pkwy Chesapeake VA 23320 General <strong>Provider</strong> Chesapeake City<br />

* Chawla Seema 050722 Konikoff <strong>Dental</strong> Associates 684 Battlefield Blvd Chesapeake VA 23320 General <strong>Provider</strong> Chesapeake City<br />

* Dobson Roberta 068512 Konikoff <strong>Dental</strong> Associates 1533 Volvo Pkwy Chesapeake VA 23320 General <strong>Provider</strong> Chesapeake City<br />

* Dobson Roberta 050722 Konikoff <strong>Dental</strong> Associates 684 Battlefield Blvd Chesapeake VA 23320 General <strong>Provider</strong> Chesapeake City<br />

* Dobson, III Joseph 068512 Konikoff <strong>Dental</strong> Associates 1533 Volvo Pkwy Chesapeake VA 23320 General <strong>Provider</strong> Chesapeake City<br />

* Dobson, III Joseph 050722 Konikoff <strong>Dental</strong> Associates 684 Battlefield Blvd Chesapeake VA 23320 General <strong>Provider</strong> Chesapeake City<br />

* Elosta Wael 068512 Konikoff <strong>Dental</strong> Associates 1533 Volvo Pkwy Chesapeake VA 23320 General <strong>Provider</strong> Chesapeake City<br />

* Elosta Wael 050722 Konikoff <strong>Dental</strong> Associates 684 Battlefield Blvd Chesapeake VA 23320 General <strong>Provider</strong> Chesapeake City<br />

* Field Marcus 068512 Konikoff <strong>Dental</strong> Associates 1533 Volvo Pkwy Chesapeake VA 23320 General <strong>Provider</strong> Chesapeake City<br />

* Field Marcus 050722 Konikoff <strong>Dental</strong> Associates 684 Battlefield Blvd Chesapeake VA 23320 General <strong>Provider</strong> Chesapeake City<br />

* Field Sheila 068512 Konikoff <strong>Dental</strong> Associates 1533 Volvo Pkwy Chesapeake VA 23320 General <strong>Provider</strong> Chesapeake City<br />

* Field Sheila 050722 Konikoff <strong>Dental</strong> Associates 684 Battlefield Blvd Chesapeake VA 23320 General <strong>Provider</strong> Chesapeake City<br />

* Gioffre Mollie 068512 Konikoff <strong>Dental</strong> Associates 1533 Volvo Pkwy Chesapeake VA 23320 General <strong>Provider</strong> Chesapeake City<br />

* Gioffre Mollie 050722 Konikoff <strong>Dental</strong> Associates 684 Battlefield Blvd Chesapeake VA 23320 General <strong>Provider</strong> Chesapeake City<br />

* Hoek Meredith 068512 Konikoff <strong>Dental</strong> Associates 1533 Volvo Pkwy Chesapeake VA 23320 General <strong>Provider</strong> Chesapeake City<br />

* Hoek Meredith 050722 Konikoff <strong>Dental</strong> Associates 684 Battlefield Blvd Chesapeake VA 23320 General <strong>Provider</strong> Chesapeake City<br />

* Jones Daniel 068512 Konikoff <strong>Dental</strong> Associates 1533 Volvo Pkwy Chesapeake VA 23320 General <strong>Provider</strong> Chesapeake City<br />

* Jones Daniel 050722 Konikoff <strong>Dental</strong> Associates 684 Battlefield Blvd Chesapeake VA 23320 General <strong>Provider</strong> Chesapeake City<br />

* Konikoff David 068512 Konikoff <strong>Dental</strong> Associates 1533 Volvo Pkwy Chesapeake VA 23320 General <strong>Provider</strong> Chesapeake City<br />

* Indicates dentist that is accepting current patients only.<br />

All <strong>Select</strong> <strong>Plan</strong> Dentists Page 43<br />

1 Same as a DHMO with fixed member copayments, no annual maximum dollar limits, no waiting periods, no deductibles, no pre-authorization paperwork or pre-treatment estimates and no<br />

claim forms or proof of loss (except in the case of out-of-area emergencies). Member must enroll with a General Dentist. Fac ID is used to indicate which facility a member chooses.


SELECT PLAN 1 DENTIST DIRECTORY<br />

Dentists listed are under contract as of 10/1/12<br />

Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />

* Konikoff David 050722 Konikoff <strong>Dental</strong> Associates 684 Battlefield Blvd Chesapeake VA 23320 General <strong>Provider</strong> Chesapeake City<br />

* Lanigan Jacqueline 068512 Konikoff <strong>Dental</strong> Associates 1533 Volvo Pkwy Chesapeake VA 23320 General <strong>Provider</strong> Chesapeake City<br />

* Lanigan Jacqueline 050722 Konikoff <strong>Dental</strong> Associates 684 Battlefield Blvd Chesapeake VA 23320 General <strong>Provider</strong> Chesapeake City<br />

* Maclin Ivetta 068512 Konikoff <strong>Dental</strong> Associates 1533 Volvo Pkwy Chesapeake VA 23320 General <strong>Provider</strong> Chesapeake City<br />

* Maclin Ivetta 050722 Konikoff <strong>Dental</strong> Associates 684 Battlefield Blvd Chesapeake VA 23320 General <strong>Provider</strong> Chesapeake City<br />

* Mady Zeyad 068512 Konikoff <strong>Dental</strong> Associates 1533 Volvo Pkwy Chesapeake VA 23320 General <strong>Provider</strong> Chesapeake City<br />

* Mady Zeyad 050722 Konikoff <strong>Dental</strong> Associates 684 Battlefield Blvd Chesapeake VA 23320 General <strong>Provider</strong> Chesapeake City<br />

* Maniwang Jo-Marie 068512 Konikoff <strong>Dental</strong> Associates 1533 Volvo Pkwy Chesapeake VA 23320 General <strong>Provider</strong> Chesapeake City<br />

* Maniwang Jo-Marie 050722 Konikoff <strong>Dental</strong> Associates 684 Battlefield Blvd Chesapeake VA 23320 General <strong>Provider</strong> Chesapeake City<br />

* Mattioli Michele 068512 Konikoff <strong>Dental</strong> Associates 1533 Volvo Pkwy Chesapeake VA 23320 General <strong>Provider</strong> Chesapeake City<br />

* Mattioli Michele 050722 Konikoff <strong>Dental</strong> Associates 684 Battlefield Blvd Chesapeake VA 23320 General <strong>Provider</strong> Chesapeake City<br />

* McCarty Benjamin 068512 Konikoff <strong>Dental</strong> Associates 1533 Volvo Pkwy Chesapeake VA 23320 General <strong>Provider</strong> Chesapeake City<br />

* McCarty Benjamin 050722 Konikoff <strong>Dental</strong> Associates 684 Battlefield Blvd Chesapeake VA 23320 General <strong>Provider</strong> Chesapeake City<br />

* Miranda Joshua 068512 Konikoff <strong>Dental</strong> Associates 1533 Volvo Pkwy Chesapeake VA 23320 General <strong>Provider</strong> Chesapeake City<br />

* Miranda Joshua 050722 Konikoff <strong>Dental</strong> Associates 684 Battlefield Blvd Chesapeake VA 23320 General <strong>Provider</strong> Chesapeake City<br />

* Morris Mason-Leigh 068512 Konikoff <strong>Dental</strong> Associates 1533 Volvo Pkwy Chesapeake VA 23320 General <strong>Provider</strong> Chesapeake City<br />

* Morris Mason-Leigh 050722 Konikoff <strong>Dental</strong> Associates 684 Battlefield Blvd Chesapeake VA 23320 General <strong>Provider</strong> Chesapeake City<br />

* Muldoon Catherine 068512 Konikoff <strong>Dental</strong> Associates 1533 Volvo Pkwy Chesapeake VA 23320 General <strong>Provider</strong> Chesapeake City<br />

* Muldoon Catherine 050722 Konikoff <strong>Dental</strong> Associates 684 Battlefield Blvd Chesapeake VA 23320 General <strong>Provider</strong> Chesapeake City<br />

* Parker Richard 068512 Konikoff <strong>Dental</strong> Associates 1533 Volvo Pkwy Chesapeake VA 23320 General <strong>Provider</strong> Chesapeake City<br />

* Parker Richard 050722 Konikoff <strong>Dental</strong> Associates 684 Battlefield Blvd Chesapeake VA 23320 General <strong>Provider</strong> Chesapeake City<br />

* Pearl Dina 068512 Konikoff <strong>Dental</strong> Associates 1533 Volvo Pkwy Chesapeake VA 23320 General <strong>Provider</strong> Chesapeake City<br />

* Pearl Dina 050722 Konikoff <strong>Dental</strong> Associates 684 Battlefield Blvd Chesapeake VA 23320 General <strong>Provider</strong> Chesapeake City<br />

* Reichley John 068512 Konikoff <strong>Dental</strong> Associates 1533 Volvo Pkwy Chesapeake VA 23320 General <strong>Provider</strong> Chesapeake City<br />

* Reichley John 050722 Konikoff <strong>Dental</strong> Associates 684 Battlefield Blvd Chesapeake VA 23320 General <strong>Provider</strong> Chesapeake City<br />

* Richards Damdy 068512 Konikoff <strong>Dental</strong> Associates 1533 Volvo Pkwy Chesapeake VA 23320 General <strong>Provider</strong> Chesapeake City<br />

* Richards Damdy 050722 Konikoff <strong>Dental</strong> Associates 684 Battlefield Blvd Chesapeake VA 23320 General <strong>Provider</strong> Chesapeake City<br />

* Santos Estelito 068512 Konikoff <strong>Dental</strong> Associates 1533 Volvo Pkwy Chesapeake VA 23320 General <strong>Provider</strong> Chesapeake City<br />

* Santos Estelito 050722 Konikoff <strong>Dental</strong> Associates 684 Battlefield Blvd Chesapeake VA 23320 General <strong>Provider</strong> Chesapeake City<br />

* Solarte-Castro Edith 068512 Konikoff <strong>Dental</strong> Associates 1533 Volvo Pkwy Chesapeake VA 23320 General <strong>Provider</strong> Chesapeake City<br />

* Solarte-Castro Edith 050722 Konikoff <strong>Dental</strong> Associates 684 Battlefield Blvd Chesapeake VA 23320 General <strong>Provider</strong> Chesapeake City<br />

* Tam Amy 068512 Konikoff <strong>Dental</strong> Associates 1533 Volvo Pkwy Chesapeake VA 23320 General <strong>Provider</strong> Chesapeake City<br />

*Tam Amy 050722 Konikoff <strong>Dental</strong> Associates 684 Battlefield Blvd Chesapeake VA 23320 General <strong>Provider</strong> Chesapeake City<br />

* Throckmorton Maria 068512 Konikoff <strong>Dental</strong> Associates 1533 Volvo Pkwy Chesapeake VA 23320 General <strong>Provider</strong> Chesapeake City<br />

* Throckmorton Maria 050722 Konikoff <strong>Dental</strong> Associates 684 Battlefield Blvd Chesapeake VA 23320 General <strong>Provider</strong> Chesapeake City<br />

Reynolds Jillian 078272 LWSS Dentistry for Children 1230 Progressive Dr, Suite 103 Chesapeake VA 23320 Pedodontist Chesapeake City<br />

Sachs Scott 078272 LWSS Dentistry for Children 1230 Progressive Dr, Suite 103 Chesapeake VA 23320 Pedodontist Chesapeake City<br />

Kaplan Marvin 000132 Marvin Kaplan, D.D.S., P.C. 113 Byron St. Chesapeake VA 23320 Orthodontist Chesapeake City<br />

Ashby John 002869 Owens and Dorfman, LTD 1021 N. Eden Way, Suite 128 Chesapeake VA 23320 Orthodontist Chesapeake City<br />

Dailey Curtis 002869 Owens and Dorfman, LTD 1021 N. Eden Way, Suite 128 Chesapeake VA 23320 Orthodontist Chesapeake City<br />

Quigg Richard 002765 Richard K. Quigg, D.D.S. 505 Independence Parkway, Suite 108 Chesapeake VA 23320 Oral Surgeon Chesapeake City<br />

Morrison Sanford 000722 S. Neil Morrison, DDS, & Melvin R. Morrison, DDS 1230 Progressive Center, Suite 102 Chesapeake VA 23320 Oral Surgeon Chesapeake City<br />

Byrnside Valerie 068494 Scott R Goodove DDS PLC 1533 Volvo Parkway, Suite 250 Chesapeake VA 23320 Oral Surgeon Chesapeake City<br />

Goodove Scott 068494 Scott R Goodove DDS PLC 1533 Volvo Parkway, Suite 250 Chesapeake VA 23320 Oral Surgeon Chesapeake City<br />

Harris Christopher 068494 Scott R Goodove DDS PLC 1533 Volvo Parkway, Suite 250 Chesapeake VA 23320 Oral Surgeon Chesapeake City<br />

* Abdelwahab Tamer 050721 Konikoff <strong>Dental</strong> Associates 1419 Cedar Rd Chesapeake VA 23322 General <strong>Provider</strong> Chesapeake City<br />

* Ansari Uzma 050721 Konikoff <strong>Dental</strong> Associates 1419 Cedar Rd Chesapeake VA 23322 General <strong>Provider</strong> Chesapeake City<br />

* Berrada Sanae 050721 Konikoff <strong>Dental</strong> Associates 1419 Cedar Rd Chesapeake VA 23322 General <strong>Provider</strong> Chesapeake City<br />

* Bozman Jenny 050721 Konikoff <strong>Dental</strong> Associates 1419 Cedar Rd Chesapeake VA 23322 General <strong>Provider</strong> Chesapeake City<br />

* Chawla Seema 050721 Konikoff <strong>Dental</strong> Associates 1419 Cedar Rd Chesapeake VA 23322 General <strong>Provider</strong> Chesapeake City<br />

* Dobson Roberta 050721 Konikoff <strong>Dental</strong> Associates 1419 Cedar Rd Chesapeake VA 23322 General <strong>Provider</strong> Chesapeake City<br />

* Dobson, III Joseph 050721 Konikoff <strong>Dental</strong> Associates 1419 Cedar Rd Chesapeake VA 23322 General <strong>Provider</strong> Chesapeake City<br />

* Elosta Wael 050721 Konikoff <strong>Dental</strong> Associates 1419 Cedar Rd Chesapeake VA 23322 General <strong>Provider</strong> Chesapeake City<br />

* Field Marcus 050721 Konikoff <strong>Dental</strong> Associates 1419 Cedar Rd Chesapeake VA 23322 General <strong>Provider</strong> Chesapeake City<br />

* Field Sheila 050721 Konikoff <strong>Dental</strong> Associates 1419 Cedar Rd Chesapeake VA 23322 General <strong>Provider</strong> Chesapeake City<br />

* Gioffre Mollie 050721 Konikoff <strong>Dental</strong> Associates 1419 Cedar Rd Chesapeake VA 23322 General <strong>Provider</strong> Chesapeake City<br />

* Hoek Meredith 050721 Konikoff <strong>Dental</strong> Associates 1419 Cedar Rd Chesapeake VA 23322 General <strong>Provider</strong> Chesapeake City<br />

* Jones Daniel 050721 Konikoff <strong>Dental</strong> Associates 1419 Cedar Rd Chesapeake VA 23322 General <strong>Provider</strong> Chesapeake City<br />

* Konikoff David 050721 Konikoff <strong>Dental</strong> Associates 1419 Cedar Rd Chesapeake VA 23322 General <strong>Provider</strong> Chesapeake City<br />

* Lanigan Jacqueline 050721 Konikoff <strong>Dental</strong> Associates 1419 Cedar Rd Chesapeake VA 23322 General <strong>Provider</strong> Chesapeake City<br />

* Maclin Ivetta 050721 Konikoff <strong>Dental</strong> Associates 1419 Cedar Rd Chesapeake VA 23322 General <strong>Provider</strong> Chesapeake City<br />

* Mady Zeyad 050721 Konikoff <strong>Dental</strong> Associates 1419 Cedar Rd Chesapeake VA 23322 General <strong>Provider</strong> Chesapeake City<br />

* Maniwang Jo-Marie 050721 Konikoff <strong>Dental</strong> Associates 1419 Cedar Rd Chesapeake VA 23322 General <strong>Provider</strong> Chesapeake City<br />

* Mattioli Michele 050721 Konikoff <strong>Dental</strong> Associates 1419 Cedar Rd Chesapeake VA 23322 General <strong>Provider</strong> Chesapeake City<br />

* McCarty Benjamin 050721 Konikoff <strong>Dental</strong> Associates 1419 Cedar Rd Chesapeake VA 23322 General <strong>Provider</strong> Chesapeake City<br />

* Miranda Joshua 050721 Konikoff <strong>Dental</strong> Associates 1419 Cedar Rd Chesapeake VA 23322 General <strong>Provider</strong> Chesapeake City<br />

* Indicates dentist that is accepting current patients only.<br />

All <strong>Select</strong> <strong>Plan</strong> Dentists Page 44<br />

1 Same as a DHMO with fixed member copayments, no annual maximum dollar limits, no waiting periods, no deductibles, no pre-authorization paperwork or pre-treatment estimates and no<br />

claim forms or proof of loss (except in the case of out-of-area emergencies). Member must enroll with a General Dentist. Fac ID is used to indicate which facility a member chooses.


SELECT PLAN 1 DENTIST DIRECTORY<br />

Dentists listed are under contract as of 10/1/12<br />

Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />

* Morris Mason-Leigh 050721 Konikoff <strong>Dental</strong> Associates 1419 Cedar Rd Chesapeake VA 23322 General <strong>Provider</strong> Chesapeake City<br />

* Muldoon Catherine 050721 Konikoff <strong>Dental</strong> Associates 1419 Cedar Rd Chesapeake VA 23322 General <strong>Provider</strong> Chesapeake City<br />

* Parker Richard 050721 Konikoff <strong>Dental</strong> Associates 1419 Cedar Rd Chesapeake VA 23322 General <strong>Provider</strong> Chesapeake City<br />

* Pearl Dina 050721 Konikoff <strong>Dental</strong> Associates 1419 Cedar Rd Chesapeake VA 23322 General <strong>Provider</strong> Chesapeake City<br />

* Reichley John 050721 Konikoff <strong>Dental</strong> Associates 1419 Cedar Rd Chesapeake VA 23322 General <strong>Provider</strong> Chesapeake City<br />

* Richards Damdy 050721 Konikoff <strong>Dental</strong> Associates 1419 Cedar Rd Chesapeake VA 23322 General <strong>Provider</strong> Chesapeake City<br />

* Santos Estelito 050721 Konikoff <strong>Dental</strong> Associates 1419 Cedar Rd Chesapeake VA 23322 General <strong>Provider</strong> Chesapeake City<br />

* Solarte-Castro Edith 050721 Konikoff <strong>Dental</strong> Associates 1419 Cedar Rd Chesapeake VA 23322 General <strong>Provider</strong> Chesapeake City<br />

* Tam Amy 050721 Konikoff <strong>Dental</strong> Associates 1419 Cedar Rd Chesapeake VA 23322 General <strong>Provider</strong> Chesapeake City<br />

* Throckmorton Maria 050721 Konikoff <strong>Dental</strong> Associates 1419 Cedar Rd Chesapeake VA 23322 General <strong>Provider</strong> Chesapeake City<br />

Cobb Howard 000676 Howard P. Cobb, D.D.S. 2605 Moses Grandy Trl., Suite B Chesapeake VA 23323 General <strong>Provider</strong> Chesapeake City<br />

Howard Robert 000021 Robert J. Howard, D.D.S. 308 N. George Wash. Hwy, Suite 2 Chesapeake VA 23323 General <strong>Provider</strong> Chesapeake City<br />

Barbour Robert 000079 Robert K Barbour, DMD, PC 2520 Gilmerton Rd. Chesapeake VA 23323 General <strong>Provider</strong> Chesapeake City<br />

Tran Anh 050571 Chester Orthodontics 11300 Ironbridge Rd, Suite B Chester VA 23831 Orthodontist Chesterfield<br />

Rodrigues Shwetha 002817 Shwetha Rodrigues DDS PC 12619 Jefferson Davis Hwy Chester VA 23831 General <strong>Provider</strong> Chesterfield<br />

Brown Stephen 000301 Chesterfield Oral Surgery, <strong>Inc</strong>. 10110 Iron Bridge Rd. Chesterfield VA 23832 Oral Surgeon Chesterfield<br />

Rhea William 000100 William H. Rhea, D.D.S. 10108 Krause Rd. #102 Chesterfield VA 23832 General <strong>Provider</strong> Chesterfield<br />

Kelleher Kevin 037690 Kelleher Orthodontics 2412 Colony Crossing Pl Midlothian VA 23112 Orthodontist Chesterfield<br />

Padgett Thomas 000313 Richmond Oral & Cosmetic Surgeons 5921 Harbour Lane, Suite 200 Midlothian VA 23112 Oral Surgeon Chesterfield<br />

Wallace James 000313 Richmond Oral & Cosmetic Surgeons 5921 Harbour Lane, Suite 200 Midlothian VA 23112 Oral Surgeon Chesterfield<br />

Agnihotri Neil 002381 Virginia Oral & Facial Surgery 6031 Harbour Park Dr Midlothian VA 23112 Oral Surgeon Chesterfield<br />

Alexander John 002381 Virginia Oral & Facial Surgery 6031 Harbour Park Dr Midlothian VA 23112 Oral Surgeon Chesterfield<br />

Dymon William 002381 Virginia Oral & Facial Surgery 6031 Harbour Park Dr Midlothian VA 23112 Oral Surgeon Chesterfield<br />

Harris Monroe 002381 Virginia Oral & Facial Surgery 6031 Harbour Park Dr Midlothian VA 23112 Oral Surgeon Chesterfield<br />

Keeney Kanyon 002381 Virginia Oral & Facial Surgery 6031 Harbour Park Dr Midlothian VA 23112 Oral Surgeon Chesterfield<br />

Metzger Lawrence 002381 Virginia Oral & Facial Surgery 6031 Harbour Park Dr Midlothian VA 23112 Oral Surgeon Chesterfield<br />

Watson Damon 002381 Virginia Oral & Facial Surgery 6031 Harbour Park Dr Midlothian VA 23112 Oral Surgeon Chesterfield<br />

Wlodawsky Ross 002381 Virginia Oral & Facial Surgery 6031 Harbour Park Dr Midlothian VA 23112 Oral Surgeon Chesterfield<br />

Gray Richard 072103 Apex Endodontics 1149 Jefferson Green Cir Midlothian VA 23113 Endodontist Chesterfield<br />

Kim John 000005 John J Kim DDS 2927 Polo Parkway Midlothian VA 23113 General <strong>Provider</strong> Chesterfield<br />

Byrd Richard 002394 Richard L. Byrd., D.D.S. 2929 Polo Parkway Midlothian VA 23113 Orthodontist Chesterfield<br />

Padgett Thomas 000314 Richmond Oral & Cosmetic Surgeons 1680 Huguenot Rd. Midlothian VA 23113 Oral Surgeon Chesterfield<br />

Wallace James 000314 Richmond Oral & Cosmetic Surgeons 1680 Huguenot Rd. Midlothian VA 23113 Oral Surgeon Chesterfield<br />

Agnihotri Neil 000250 Virginia Oral & Facial Surgery 11319 Polo Place Midlothian VA 23113 Oral Surgeon Chesterfield<br />

Alexander John 000250 Virginia Oral & Facial Surgery 11319 Polo Place Midlothian VA 23113 Oral Surgeon Chesterfield<br />

Dymon William 000250 Virginia Oral & Facial Surgery 11319 Polo Place Midlothian VA 23113 Oral Surgeon Chesterfield<br />

Harris Monroe 000250 Virginia Oral & Facial Surgery 11319 Polo Place Midlothian VA 23113 Oral Surgeon Chesterfield<br />

Keeney Kanyon 000250 Virginia Oral & Facial Surgery 11319 Polo Place Midlothian VA 23113 Oral Surgeon Chesterfield<br />

Metzger Lawrence 000250 Virginia Oral & Facial Surgery 11319 Polo Place Midlothian VA 23113 Oral Surgeon Chesterfield<br />

Watson Damon 000250 Virginia Oral & Facial Surgery 11319 Polo Place Midlothian VA 23113 Oral Surgeon Chesterfield<br />

Wlodawsky Ross 000250 Virginia Oral & Facial Surgery 11319 Polo Place Midlothian VA 23113 Oral Surgeon Chesterfield<br />

Patel Nrupur 033886 Railey Hill <strong>Dental</strong> 125 Browns Way Road Midlothian VA 23114 General <strong>Provider</strong> Chesterfield<br />

Jarvandi Fereshteh 000055 Fereshteh Jaravandi, D.D.S. 4712 Jefferson Davis Hwy. Richmond VA 23234 General <strong>Provider</strong> Chesterfield<br />

Stoner Kenneth 000036 Kenneth E Stoner DDS Family Dentistry 4106 A Meadowdale Blvd Richmond VA 23234 General <strong>Provider</strong> Chesterfield<br />

Anderson Ralph 000099 Dr. Oley and Quilez, D.D.S., PLC 1907 West Huguenot Rd. Richmond VA 23235 Orthodontist Chesterfield<br />

Benson Wakeshi 000099 Dr. Oley and Quilez, D.D.S., PLC 1907 West Huguenot Rd. Richmond VA 23235 Orthodontist Chesterfield<br />

Gerber Sarah 000099 Dr. Oley and Quilez, D.D.S., PLC 1907 West Huguenot Rd. Richmond VA 23235 General <strong>Provider</strong> Chesterfield<br />

Hoover Amanda 000099 Dr. Oley and Quilez, D.D.S., PLC 1907 West Huguenot Rd. Richmond VA 23235 General <strong>Provider</strong> Chesterfield<br />

Oley George 000099 Dr. Oley and Quilez, D.D.S., PLC 1907 West Huguenot Rd. Richmond VA 23235 General <strong>Provider</strong> Chesterfield<br />

Quilez Robert 000099 Dr. Oley and Quilez, D.D.S., PLC 1907 West Huguenot Rd. Richmond VA 23235 General <strong>Provider</strong> Chesterfield<br />

Whitman Kime 000099 Dr. Oley and Quilez, D.D.S., PLC 1907 West Huguenot Rd. Richmond VA 23235 General <strong>Provider</strong> Chesterfield<br />

Saroff Stephen 000737 Stephen Saroff, D.D.S. 2801 McRae Rd. Richmond VA 23235 Periodontist Chesterfield<br />

Morrison Julius 000034 Julius V. Morrison, D.D.S. 3501 Courthouse Rd. Richmond VA 23236 General <strong>Provider</strong> Chesterfield<br />

Alkilani Tawfiq 000020 Sam E English II DDS LLC 798 Southpark Blvd., Suite 26 Colonial Heights VA 23834 General <strong>Provider</strong> Colonial Heights<br />

English, II Sam 000020 Sam E English II DDS LLC 798 Southpark Blvd., Suite 26 Colonial Heights VA 23834 General <strong>Provider</strong> Colonial Heights<br />

Dickson Stephanie 033865 Dickson <strong>Dental</strong> PC 5962 Richmond Hwy Alexandria VA 22303 General <strong>Provider</strong> Fairfax<br />

Nguyen Quynh Trang 001891 Virginia <strong>Dental</strong> Center 6230-C North King's Highway Alexandria VA 22303 General <strong>Provider</strong> Fairfax<br />

Nguyen Tuong-Van 001891 Virginia <strong>Dental</strong> Center 6230-C North King's Highway Alexandria VA 22303 General <strong>Provider</strong> Fairfax<br />

Parsa Mitra 037763 Alexandria Orthodontics 2616 Sherwood Hall Ln Alexandria VA 22306 Orthodontist Fairfax<br />

Henry Rolin 001983 Rolin S. Henry, D.D.S., P.C. 7900 Andrus Road, Suite #2 Alexandria VA 22306 Oral Surgeon Fairfax<br />

* Nguyen Steve 050839 Impression <strong>Dental</strong> <strong>Inc</strong>. 6167 Fuller Ct. Alexandria VA 22310 General <strong>Provider</strong> Fairfax<br />

Sharafi Alireza 050937 Smileville LLC 6354 Walker Ln, Suite 103 Alexandria VA 22310 General <strong>Provider</strong> Fairfax<br />

Dadkhah Mina 050941 Smileville Pediatrics 6354 Walker Ln, Suite 103 Alexandria VA 22310 Pedodontist Fairfax<br />

Kumra Shawn 078281 Elegant Smiles <strong>Dental</strong> Care 4810 Beauregard St, Suite 300 Alexandria VA 22312 General <strong>Provider</strong> Fairfax<br />

Khalefa Said 001269 Said M Khalefa DDS PC 4600 Pincrest Office Park Dr., Suite B Alexandria VA 22312 General <strong>Provider</strong> Fairfax<br />

Phan Phuong 050919 Kingstowne Family & Cosmetic Dentistry 5960 Kingstowne Town Center, Suite 140 Alexandria VA 22315 General <strong>Provider</strong> Fairfax<br />

* Indicates dentist that is accepting current patients only.<br />

All <strong>Select</strong> <strong>Plan</strong> Dentists Page 45<br />

1 Same as a DHMO with fixed member copayments, no annual maximum dollar limits, no waiting periods, no deductibles, no pre-authorization paperwork or pre-treatment estimates and no<br />

claim forms or proof of loss (except in the case of out-of-area emergencies). Member must enroll with a General Dentist. Fac ID is used to indicate which facility a member chooses.


SELECT PLAN 1 DENTIST DIRECTORY<br />

Dentists listed are under contract as of 10/1/12<br />

Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />

Djeu Stephanie 050974 The Virginia Endodontic Group-Kingstowne 6831Sir Viceroy Dr, Suite 210 Alexandria VA 22315 Endodontist Fairfax<br />

Lee Brian 050974 The Virginia Endodontic Group-Kingstowne 6831Sir Viceroy Dr, Suite 210 Alexandria VA 22315 Endodontist Fairfax<br />

Ngo Tu-Son 050974 The Virginia Endodontic Group-Kingstowne 6831Sir Viceroy Dr, Suite 210 Alexandria VA 22315 Endodontist Fairfax<br />

Smernoff Gerald 000183 Gerald N. Smernoff, D.D.S., PC 7501 Little River Turnpike Annandale VA 22003 Orthodontist Fairfax<br />

Vroom Katherine 002588 Katherine M. Vroom, DDS 7027 Evergreen Court Annandale VA 22003 Orthodontist Fairfax<br />

Aulakh Navdeep 061339 Navdeep Aulakh DDS PLLC 4231 Markham St, Suite 214 Annandale VA 22003 General <strong>Provider</strong> Fairfax<br />

Cantor David 002247 Northern Virginia Oral and Maxillofacial Surgery 7611 Little River Turnpike, Suite 101-E Annandale VA 22003 Oral Surgeon Fairfax<br />

Francioni Sonia 002247 Northern Virginia Oral and Maxillofacial Surgery 7611 Little River Turnpike, Suite 101-E Annandale VA 22003 Oral Surgeon Fairfax<br />

LaBriola J. Daniel 002247 Northern Virginia Oral and Maxillofacial Surgery 7611 Little River Turnpike, Suite 101-E Annandale VA 22003 Oral Surgeon Fairfax<br />

Zadeh Hugh 002247 Northern Virginia Oral and Maxillofacial Surgery 7611 Little River Turnpike, Suite 101-E Annandale VA 22003 Oral Surgeon Fairfax<br />

Le Thien 050376 Springdale Dentistry 5105 C Backlick Rd Annandale VA 22003 General <strong>Provider</strong> Fairfax<br />

Palizi Alireza 050466 Alireza Palizi DDS PC 5216-A Lyngate ct. Burke VA 22015 General <strong>Provider</strong> Fairfax<br />

Gupta Raja 050454 <strong>Dental</strong> First Associates LLC 9570-A Burke Rd Burke VA 22015 General <strong>Provider</strong> Fairfax<br />

Jabbari Farnaz 000074 Hashem Sedaghatpour, D.M.D. 5631-D Burke Centre Parkway Burke VA 22015 General <strong>Provider</strong> Fairfax<br />

Kasper Frinet 000074 Hashem Sedaghatpour, D.M.D. 5631-D Burke Centre Parkway Burke VA 22015 General <strong>Provider</strong> Fairfax<br />

Sedaghatpour Hashem 000074 Hashem Sedaghatpour, D.M.D. 5631-D Burke Centre Parkway Burke VA 22015 General <strong>Provider</strong> Fairfax<br />

Pham Dieu 002789 Mia Pham, D.D.S. 8989 Fern Park Drive Burke VA 22015 General <strong>Provider</strong> Fairfax<br />

Naimi Amir 061403 NOVA Oral Maxillofacial & Implant Surgery 5206 Lyngate Ct Burke VA 22015 Oral Surgeon Fairfax<br />

Stern Richard 001012 Richard K. Stern, D.D.S., P.C. Burke Professional Center, 5213-B Lyngate Ct. Burke VA 22015 Orthodontist Fairfax<br />

Kim Young 037680 Young Smile <strong>Dental</strong> 9000 Fern Park Dr, A2 Burke VA 22015 General <strong>Provider</strong> Fairfax<br />

McDonough James 000182 James M. McDonough, D.D.S. 5731 Centre Square Dr Centreville VA 20120 Orthodontist Fairfax<br />

* Soltani Jim 001452 Jim J. Soltani, D.D.S. & Associates, P.C. 6019 Centreville Crest Lane Centreville VA 20121 General <strong>Provider</strong> Fairfax<br />

Filippone Louis 050563 Louis C Filippone DDS PC 6138 Redwood Sq, Suite 103 Centreville VA 20121 Orthodontist Fairfax<br />

Kim JoongSeo 033882 Pearlbrite <strong>Dental</strong> Group PLLC 14631 Lee Highway, Suite 116 Centreville VA 20121 Prosthodontist Fairfax<br />

Ali Wissam 037712 Relaxed Dentistry 14631 Lee Hwy, 301 Centreville VA 20121 General <strong>Provider</strong> Fairfax<br />

Ayass Mohamad 061304 Relaxed Dentistry 14631 Lee Hwy, Suite 301 Centreville VA 20121 General <strong>Provider</strong> Fairfax<br />

Shu Man 061402 V Care <strong>Dental</strong> LLC 14631 Lee Hwy, Suite 117 Centreville VA 20121 General <strong>Provider</strong> Fairfax<br />

Huynh Thuylinh 050349 Chantilly <strong>Dental</strong> Center Orthodontics 3901 Centreview Dr, Suite T Chantilly VA 20151 Orthodontist Fairfax<br />

Galliani Alvare Mirtha 050348 Chantilly <strong>Dental</strong> Center Specialists 3901 Centreview Dr, Suite T Chantilly VA 20151 Pedodontist Fairfax<br />

Lan Steve 050348 Chantilly <strong>Dental</strong> Center Specialists 3901 Centreview Dr, Suite T Chantilly VA 20151 Pedodontist Fairfax<br />

Liewehr Frederick 050348 Chantilly <strong>Dental</strong> Center Specialists 3901 Centreview Dr, Suite T Chantilly VA 20151 Endodontist Fairfax<br />

Nguyen Phuong 050348 Chantilly <strong>Dental</strong> Center Specialists 3901 Centreview Dr, Suite T Chantilly VA 20151 Oral Surgeon Fairfax<br />

Baveja Julie 050972 Children's <strong>Dental</strong> Care 14102 Robert Paris Ct Chantilly VA 20151 Pedodontist Fairfax<br />

Ali Amal 037667 Diamond <strong>Dental</strong> Care 13948 Lee Jackson Memorial Hwy Chantilly VA 20151 General <strong>Provider</strong> Fairfax<br />

Johnson Gary 050335 Diamond <strong>Dental</strong> Care Endodontist 13948 Lee Jackson Mem Hwy Chantilly VA 20151 Endodontist Fairfax<br />

* Chaenkwok Don 001387 Donald Chaenkwok, D.D.S. 14012B Sullyfield Circle Chantilly VA 20151 General <strong>Provider</strong> Fairfax<br />

Djeu Stephanie 037661 The Virginia Endodontic Group PLC 14149-B Robert Paris Ct. Chantilly VA 20151 Endodontist Fairfax<br />

Huang Tong-Yen 037661 The Virginia Endodontic Group PLC 14149-B Robert Paris Ct. Chantilly VA 20151 Endodontist Fairfax<br />

Lee Brian 037661 The Virginia Endodontic Group PLC 14149-B Robert Paris Ct. Chantilly VA 20151 Endodontist Fairfax<br />

Ngo Tu-Son 037661 The Virginia Endodontic Group PLC 14149-B Robert Paris Ct. Chantilly VA 20151 Endodontist Fairfax<br />

Papp Richard 070989 Westfields Dentistry 4530 Walney Rd, Suite 102 Chantilly VA 20151 General <strong>Provider</strong> Fairfax<br />

Zamora-Rojas Carla 070989 Westfields Dentistry 4530 Walney Rd, Suite 102 Chantilly VA 20151 General <strong>Provider</strong> Fairfax<br />

Berman Robert 000217 Drs Berman & Miller DDS 9942 Main Street Fairfax VA 22031 General <strong>Provider</strong> Fairfax<br />

Miller Jeffrey 000217 Drs Berman & Miller DDS 9942 Main Street Fairfax VA 22031 General <strong>Provider</strong> Fairfax<br />

Banawar Rohini 000523 Howard Hoffman, D.D.S., P.C. 9661 -C Main Street Fairfax VA 22031 General <strong>Provider</strong> Fairfax<br />

Colospate Vidya 000523 Howard Hoffman, D.D.S., P.C. 9661 -C Main Street Fairfax VA 22031 General <strong>Provider</strong> Fairfax<br />

Hoffman Howard 000523 Howard Hoffman, D.D.S., P.C. 9661 -C Main Street Fairfax VA 22031 General <strong>Provider</strong> Fairfax<br />

Nguyen Nikki 000523 Howard Hoffman, D.D.S., P.C. 9661 -C Main Street Fairfax VA 22031 Orthodontist Fairfax<br />

Rahman Murshad 000523 Howard Hoffman, D.D.S., P.C. 9661 -C Main Street Fairfax VA 22031 General <strong>Provider</strong> Fairfax<br />

Wang Peng 000523 Howard Hoffman, D.D.S., P.C. 9661 -C Main Street Fairfax VA 22031 General <strong>Provider</strong> Fairfax<br />

Zurmati Farid 000523 Howard Hoffman, D.D.S., P.C. 9661 -C Main Street Fairfax VA 22031 General <strong>Provider</strong> Fairfax<br />

Chou Melanie 050931 Howard Hoffman, D.D.S., P.C. Specialists 9661 C Main St Fairfax VA 22031 Periodontist Fairfax<br />

Kessler Joel 050931 Howard Hoffman, D.D.S., P.C. Specialists 9661 C Main St Fairfax VA 22031 Endodontist Fairfax<br />

Le Kathy 050931 Howard Hoffman, D.D.S., P.C. Specialists 9661 C Main St Fairfax VA 22031 Endodontist Fairfax<br />

McDonough James 000181 James M. McDonough, D.D.S. 9508-B Lee Hwy. Fairfax VA 22031 Orthodontist Fairfax<br />

Choi Mark 002255 Mark K. Choi, D.D.S., P.C. 8301 Arlington Boulevard, Suite 503 Fairfax VA 22031 General <strong>Provider</strong> Fairfax<br />

Small Neil 000218 Neil J. Small, D.D.S., PC 9940 Main Street Fairfax VA 22031 Endodontist Fairfax<br />

Le Trung 037961 Trung Q. Le, DDS 9600-I Main St Fairfax VA 22031 General <strong>Provider</strong> Fairfax<br />

Joo Chuck 002529 Chuck C. Joo, D.M.D. 12011 Lee Jackson Mem. Hwy., 104 Fairfax VA 22033 General <strong>Provider</strong> Fairfax<br />

Suk Minjeong 050398 Minjeong Suk DDS PC 4001 Fair Ridge Dr, Suite 105 Fairfax VA 22033 General <strong>Provider</strong> Fairfax<br />

Jaber Margarita 037710 Mira <strong>Dental</strong> Care 5671 Columbia Pike, 101 Falls Church VA 22041 General <strong>Provider</strong> Fairfax<br />

Mogharbel Tarek 037710 Mira <strong>Dental</strong> Care 5671 Columbia Pike, 101 Falls Church VA 22041 General <strong>Provider</strong> Fairfax<br />

Mohiuddin Sumayra 037710 Mira <strong>Dental</strong> Care 5671 Columbia Pike, 101 Falls Church VA 22041 General <strong>Provider</strong> Fairfax<br />

Coleman Norman 001326 Norman K. Coleman, D.D.S. 5205 Leesburg Pike, #509 Falls Church VA 22041 Oral Surgeon Fairfax<br />

Amouhashem Parvin 001544 Smile <strong>Dental</strong> Clinic 3817-A S. George Mason Drive Falls Church VA 22041 General <strong>Provider</strong> Fairfax<br />

Nassar Fadwa 002845 Falls Church Family and Comprehensive Dentistry 6400 Arlington Blvd., Suite 944 Falls Church VA 22042 General <strong>Provider</strong> Fairfax<br />

* Indicates dentist that is accepting current patients only.<br />

All <strong>Select</strong> <strong>Plan</strong> Dentists Page 46<br />

1 Same as a DHMO with fixed member copayments, no annual maximum dollar limits, no waiting periods, no deductibles, no pre-authorization paperwork or pre-treatment estimates and no<br />

claim forms or proof of loss (except in the case of out-of-area emergencies). Member must enroll with a General Dentist. Fac ID is used to indicate which facility a member chooses.


SELECT PLAN 1 DENTIST DIRECTORY<br />

Dentists listed are under contract as of 10/1/12<br />

Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />

* Kangarloo Ramineh 050943 Gentle Touch Dentistry for All Ages 6521 Arlington Blvd, Suite 112 Falls Church VA 22042 General <strong>Provider</strong> Fairfax<br />

Kaur Taran 002124 Optimum <strong>Dental</strong> 7389 Lee Highway, Suite 101 Falls Church VA 22042 General <strong>Provider</strong> Fairfax<br />

Shroff Amisha 050547 Apt <strong>Dental</strong> Associates 7115 Leesburg Pike, Suite 216 Falls Church VA 22043 General <strong>Provider</strong> Fairfax<br />

Moller James 000815 Drs. Seigel & Moller 7641 Leesburg Pike Falls Church VA 22043 General <strong>Provider</strong> Fairfax<br />

Seigel Harold 000815 Drs. Seigel & Moller 7641 Leesburg Pike Falls Church VA 22043 General <strong>Provider</strong> Fairfax<br />

Kermanshi Shiva 033844 Arlington <strong>Dental</strong> Care PLLC 6060 Arlington Blvd. Falls Church VA 22044 Orthodontist Fairfax<br />

Solemaninejad Homan 033844 Arlington <strong>Dental</strong> Care PLLC 6060 Arlington Blvd. Falls Church VA 22044 General <strong>Provider</strong> Fairfax<br />

Vu Bao 000178 Bao T. Vu, D.D.S. 6081 Arlington Blvd. Falls Church VA 22044 Orthodontist Fairfax<br />

Patterson Travis 001103 Drs. Whiston, Patterson & Corcoran 6400 Arlington Blvd., Plaza 1 Lower Level Falls Church VA 22044 Oral Surgeon Fairfax<br />

Gregory Eugene 000121 Eugene W. Gregory, D.D.S. 6231 Leesburg Pike #402 Falls Church VA 22044 Oral Surgeon Fairfax<br />

Dang Quynh-Anh 051063 Sleepy Hollow <strong>Dental</strong> PLLC 2946 Sleepy Hollow Rd, Suite 1B Falls Church VA 22044 General <strong>Provider</strong> Fairfax<br />

Le Yen 051063 Sleepy Hollow <strong>Dental</strong> PLLC 2946 Sleepy Hollow Rd, Suite 1B Falls Church VA 22044 General <strong>Provider</strong> Fairfax<br />

Doppalapudi Vivek 001301 Vivek Doppalapudi, D.D.S. 102 Elden St., Ste 19 Herndon VA 20170 Periodontist Fairfax<br />

Alayssami Mazin 000092 Bright Now <strong>Dental</strong> 13873 Park Center Rd., Suite 137 Herndon VA 20171 General <strong>Provider</strong> Fairfax<br />

Byrd Richard 000092 Bright Now <strong>Dental</strong> 13873 Park Center Rd., Suite 137 Herndon VA 20171 Orthodontist Fairfax<br />

Chaddad Karim 000092 Bright Now <strong>Dental</strong> 13873 Park Center Rd., Suite 137 Herndon VA 20171 Periodontist Fairfax<br />

DeVylder Joseph 000092 Bright Now <strong>Dental</strong> 13873 Park Center Rd., Suite 137 Herndon VA 20171 Oral Surgeon Fairfax<br />

Ornoff Mark 000092 Bright Now <strong>Dental</strong> 13873 Park Center Rd., Suite 137 Herndon VA 20171 General <strong>Provider</strong> Fairfax<br />

Reedy Hima-Bindu 000092 Bright Now <strong>Dental</strong> 13873 Park Center Rd., Suite 137 Herndon VA 20171 General <strong>Provider</strong> Fairfax<br />

Chaddad Karim 050927 Mazin Alayssami DMD & Associates PC Specialists 13873 Park Center Rd, Suite 137 Herndon VA 20171 Periodontist Fairfax<br />

DeVylder Joseph 050927 Mazin Alayssami DMD & Associates PC Specialists 13873 Park Center Rd, Suite 137 Herndon VA 20171 Oral Surgeon Fairfax<br />

Kuppam Swathi 051120 All Smiles Orthodontics 9010 Lorton Station Blvd, Suite 260 Lorton VA 22079 Orthodontist Fairfax<br />

Patel Snehal 050664 Snehal Patel DDS 9010 Lorton Station Blvd, Suite 140 Lorton VA 22079 Oral Surgeon Fairfax<br />

Mogharbel Tarek 051125 Mira <strong>Dental</strong> Care at Tysons Corner 8201 Greensboro Dr, Suite 710 Mc Lean VA 22102 General <strong>Provider</strong> Fairfax<br />

Bajwa Preet 061412 A B <strong>Dental</strong> 11790 H Baron Cameron Ave Reston VA 20190 General <strong>Provider</strong> Fairfax<br />

Bordon Elda 079058 Family and Cosmetic Dentistry 1800 Michael Faraday Dr Reston VA 20190 General <strong>Provider</strong> Fairfax<br />

Naimi Amir 061404 NOVA Oral Maxillofacial & Implant Surgery 11331 Sunset Hills Rd Reston VA 20190 Oral Surgeon Fairfax<br />

Pell James 001253 Oral Surgery Associates of Northern Virginia Ltd 1800 Town Center Drive, Suite116 Reston VA 20190 Oral Surgeon Fairfax<br />

Wang Richard 001253 Oral Surgery Associates of Northern Virginia Ltd 1800 Town Center Drive, Suite116 Reston VA 20190 Oral Surgeon Fairfax<br />

Anoushfar Sherry 000926 Sherry Anoushfar, D.D.S., PC 1984 Isaac Newton Square, Suite 201 Reston VA 20190 General <strong>Provider</strong> Fairfax<br />

Izadi Moshen 000926 Sherry Anoushfar, D.D.S., PC 1984 Isaac Newton Square, Suite 201 Reston VA 20190 General <strong>Provider</strong> Fairfax<br />

Khang Wahn 001483 Perio Implant Center 11866 Sunrise Valley Drive, Suite 101 Reston VA 20191 Periodontist Fairfax<br />

Colospate Vidya 000524 Howard Hoffman, D.D.S., P.C. 6340 Brandon Ave. Springfield VA 22150 General <strong>Provider</strong> Fairfax<br />

Grande Marcos 000524 Howard Hoffman, D.D.S., P.C. 6340 Brandon Ave. Springfield VA 22150 General <strong>Provider</strong> Fairfax<br />

Hoffman Howard 000524 Howard Hoffman, D.D.S., P.C. 6340 Brandon Ave. Springfield VA 22150 General <strong>Provider</strong> Fairfax<br />

Nguyen Nikki 000524 Howard Hoffman, D.D.S., P.C. 6340 Brandon Ave. Springfield VA 22150 Orthodontist Fairfax<br />

Zarookian Armen 000524 Howard Hoffman, D.D.S., P.C. 6340 Brandon Ave. Springfield VA 22150 General <strong>Provider</strong> Fairfax<br />

Zurmati Farid 000524 Howard Hoffman, D.D.S., P.C. 6340 Brandon Ave. Springfield VA 22150 General <strong>Provider</strong> Fairfax<br />

Chou Melanie 050932 Howard Hoffman, D.D.S., P.C. Specialists 6340 Brandon Ave Springfield VA 22150 Periodontist Fairfax<br />

Gutmann J. 000200 J. Steven Gutmann, D.D.S., P.C. 6225 Brandon Ave., #185 Springfield VA 22150 Oral Surgeon Fairfax<br />

Sina Nadia 037651 MY BRACES DOCTOR, PC 6525-C Frontier Dr. Springfield VA 22150 Orthodontist Fairfax<br />

Khalefa Said 000048 Said M. Khalefa, D.D.S., P.C. 6115 Backlick Rd Springfield VA 22150 General <strong>Provider</strong> Fairfax<br />

Alayssami Mazin 000145 Bright Now <strong>Dental</strong> 2230 Gallows Rd., Suite 320 Vienna VA 22027 General <strong>Provider</strong> Fairfax<br />

Elkhateeb Mohammad 000145 Bright Now <strong>Dental</strong> 2230 Gallows Rd., Suite 320 Vienna VA 22027 General <strong>Provider</strong> Fairfax<br />

Chaddad Karim 050928 Mazin Alayssami DMD & Associates PC Specialists 2230 Gallows Rd, Suite 320 Vienna VA 22027 Periodontist Fairfax<br />

DeVylder Joseph 050928 Mazin Alayssami DMD & Associates PC Specialists 2230 Gallows Rd, Suite 320 Vienna VA 22027 Oral Surgeon Fairfax<br />

Patel Ashish 050928 Mazin Alayssami DMD & Associates PC Specialists 2230 Gallows Rd, Suite 320 Vienna VA 22027 Oral Surgeon Fairfax<br />

Schiff Basil 001481 Basil A. Schiff, D.D.S., P.C. 361 Maple Ave W, Suite 200 Vienna VA 22180 Oral Surgeon Fairfax<br />

Luna Oscar 050734 Bright Smile Pediatric Dentist 410 Pine St SE Vienna VA 22180 Pedodontist Fairfax<br />

Zadeh David 033866 Davoud Zadeh, D.D.S. 308 <strong>Dominion</strong> Rd. N.E. Vienna VA 22180 General <strong>Provider</strong> Fairfax<br />

Kim JoongSeo 033880 JoongSeo Kim, D.D.S., PC 301 Maple Ave West, Suite 610 Vienna VA 22180 Prosthodontist Fairfax<br />

DeVylder Joseph 001220 Joseph J. DeVylder, D.D.S. 407-F Church St., NE Vienna VA 22180 Oral Surgeon Fairfax<br />

Kim Sang 079780 Oral Facial and <strong>Dental</strong> Implant Surgery 361 Maple Ave West, Suite 200 Vienna VA 22180 Oral Surgeon Fairfax<br />

Dellork Richard 050350 Richard J Dellork DDS 124 Park St SE, Suite 205 Vienna VA 22180 Endodontist Fairfax<br />

Iravani Farideh 002046 Dr. Farideh Irvani, DMD-Spec 1964 Gallows Road #220 Vienna VA 22182 Periodontist Fairfax<br />

Johnson Gary 037753 Gary J. Johnson, DDS 8227 Old Courthouse Rd, 201 Vienna VA 22182 Endodontist Fairfax<br />

* Le Quan 000115 Le Smile 2070 Chain Bridge Rd., Suite 530 Vienna VA 22182 General <strong>Provider</strong> Fairfax<br />

Choby Mary 000140 Mary Ann Choby, D.M.D., MS 8133 Leesburg Pike, Suite 610 Vienna VA 22182 Endodontist Fairfax<br />

Anoushfar Sherry 001302 Sherry Anoushfar, D.D.S., PC 133 East Maple Avenue, Suite 206 Vienna VA 22182 General <strong>Provider</strong> Fairfax<br />

Izadi Moshen 001302 Sherry Anoushfar, D.D.S., PC 133 East Maple Avenue, Suite 206 Vienna VA 22182 General <strong>Provider</strong> Fairfax<br />

Alvarez Juan 033870 Tysons Corner Dentists 8296-A Old Courthouse Rd. Vienna VA 22182 Prosthodontist Fairfax<br />

Imao Josemari 033870 Tysons Corner Dentists 8296-A Old Courthouse Rd. Vienna VA 22182 General <strong>Provider</strong> Fairfax<br />

Ribeiro Alexandre 033870 Tysons Corner Dentists 8296-A Old Courthouse Rd. Vienna VA 22182 General <strong>Provider</strong> Fairfax<br />

Shu Man 033870 Tysons Corner Dentists 8296-A Old Courthouse Rd. Vienna VA 22182 General <strong>Provider</strong> Fairfax<br />

Sperling-Habot Keren 050353 Tysons Corner Dentists Specialists 8296 A Old Courthouse Rd Vienna VA 22182 Periodontist Fairfax<br />

Fariello Arnold 037553 Arnold S. Fariello, D.D.S., PC 10875 Main St., #103 Fairfax VA 22030 General <strong>Provider</strong> Fairfax City<br />

* Indicates dentist that is accepting current patients only.<br />

All <strong>Select</strong> <strong>Plan</strong> Dentists Page 47<br />

1 Same as a DHMO with fixed member copayments, no annual maximum dollar limits, no waiting periods, no deductibles, no pre-authorization paperwork or pre-treatment estimates and no<br />

claim forms or proof of loss (except in the case of out-of-area emergencies). Member must enroll with a General Dentist. Fac ID is used to indicate which facility a member chooses.


SELECT PLAN 1 DENTIST DIRECTORY<br />

Dentists listed are under contract as of 10/1/12<br />

Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />

Hong Charlie 002679 Charlie H. Hong, DMD, PC 3554 Chain Bridge Rd., Suite 401 Fairfax VA 22030 Endodontist Fairfax City<br />

Hsu Yu Kai 002679 Charlie H. Hong, DMD, PC 3554 Chain Bridge Rd., Suite 401 Fairfax VA 22030 Endodontist Fairfax City<br />

Butt Tehreem 037738 Family Dentistry of Fairfax, PC 10391 Democracy Lane, Suite A Fairfax VA 22030 General <strong>Provider</strong> Fairfax City<br />

Sina Nadia 002237 MY BRACES DOCTOR, PC 3925 Old Lee Hwy, Unit 51 C Fairfax VA 22030 Orthodontist Fairfax City<br />

Yoon Jangyeul 037759 Thomas Yoon <strong>Dental</strong> 10807 Main St, 200 Fairfax VA 22030 General <strong>Provider</strong> Fairfax City<br />

* Boyce Albert 000358 Albert M. Boyce, D.D.S. 313 Park Ave., Suite 101 Falls Church VA 22046 General <strong>Provider</strong> Falls Church City<br />

Sarraj Ali 001322 Ali Sarraj, D.M.D. & Associates, P.C. 932 West Broad St. Falls Church VA 22046 General <strong>Provider</strong> Falls Church City<br />

Christopher Lourdes 001448 Christopher & Favagehi, D.D.S., M.S. 313 Park Avenue, Suite 103 Falls Church VA 22046 Periodontist Falls Church City<br />

Favagehi Mehrdad 001448 Christopher & Favagehi, D.D.S., M.S. 313 Park Avenue, Suite 103 Falls Church VA 22046 Periodontist Falls Church City<br />

Khattak Farida 061384 Dynamic <strong>Dental</strong> PC 159 Hillwood Ave Falls Church VA 22046 General <strong>Provider</strong> Falls Church City<br />

Christopher Lourdes 000175 Perio & <strong>Dental</strong> Implant Surgery Ctr of Falls Church 313 Park Ave., Suite 103 Falls Church VA 22046 Periodontist Falls Church City<br />

Deutsch Charles 000175 Perio & <strong>Dental</strong> Implant Surgery Ctr of Falls Church 313 Park Ave., Suite 103 Falls Church VA 22046 Periodontist Falls Church City<br />

Favagehi Mehrdad 000175 Perio & <strong>Dental</strong> Implant Surgery Ctr of Falls Church 313 Park Ave., Suite 103 Falls Church VA 22046 Periodontist Falls Church City<br />

Rekow Marlin 078269 Marlin F Rekow DDS PC 127 E Shirley Ave Warrenton VA 20186 General <strong>Provider</strong> Fauquier<br />

Terrill David 001067 David Terrill, D.D.S. 1300 Thornton St. Fredericksburg VA 22401 Orthodontist Fredericksburg City<br />

Ahmed Gaafar 001730 <strong>Dental</strong> One Associates Fredericksburg PC 201 Park Hill Drive Fredericksburg VA 22401 General <strong>Provider</strong> Fredericksburg City<br />

Amin Ahmad 001730 <strong>Dental</strong> One Associates Fredericksburg PC 201 Park Hill Drive Fredericksburg VA 22401 Oral Surgeon Fredericksburg City<br />

Dayse Robert 001730 <strong>Dental</strong> One Associates Fredericksburg PC 201 Park Hill Drive Fredericksburg VA 22401 Oral Surgeon Fredericksburg City<br />

Gupta Raja 001730 <strong>Dental</strong> One Associates Fredericksburg PC 201 Park Hill Drive Fredericksburg VA 22401 General <strong>Provider</strong> Fredericksburg City<br />

Hukmani Navin 001730 <strong>Dental</strong> One Associates Fredericksburg PC 201 Park Hill Drive Fredericksburg VA 22401 Orthodontist Fredericksburg City<br />

Le Tuan 001730 <strong>Dental</strong> One Associates Fredericksburg PC 201 Park Hill Drive Fredericksburg VA 22401 General <strong>Provider</strong> Fredericksburg City<br />

Lin Thomas 001730 <strong>Dental</strong> One Associates Fredericksburg PC 201 Park Hill Drive Fredericksburg VA 22401 Periodontist Fredericksburg City<br />

Yoo Junghoon 001730 <strong>Dental</strong> One Associates Fredericksburg PC 201 Park Hill Drive Fredericksburg VA 22401 General <strong>Provider</strong> Fredericksburg City<br />

Willoughby Tasha 068492 Tranquility <strong>Dental</strong> Center PLLC 2557 Cowan Blvd Fredericksburg VA 22401 General <strong>Provider</strong> Fredericksburg City<br />

* Chung John 050569 John Chung DDS PC 1959 E Pembroke Ave Hampton VA 23663 General <strong>Provider</strong> Hampton City<br />

Scott Jon 000246 Jon L. Scott, D.D.S., M.S. 2108 Hartford Rd Hampton VA 23666 Orthodontist Hampton City<br />

Park Kyeong 002844 Kyeong Park DDS 21 Towne Center Way Hampton VA 23666 General <strong>Provider</strong> Hampton City<br />

Modeste Lorenzo 000029 Lorenzo J. Modeste, D.D.S. 2238 West Todds Lane, Suite C Hampton VA 23666 General <strong>Provider</strong> Hampton City<br />

Barnes Richard 000030 Richard D. Barnes, D.D.S. 2240 Coliseum Dr., Suite C Hampton VA 23666 General <strong>Provider</strong> Hampton City<br />

Klochak Joseph 000030 Richard D. Barnes, D.D.S. 2240 Coliseum Dr., Suite C Hampton VA 23666 General <strong>Provider</strong> Hampton City<br />

Gallop Ceceil 000038 Ceceil C. Gallop, D.D.S. 3709 Kecoughtan Rd Hampton VA 23669 General <strong>Provider</strong> Hampton City<br />

Robinson Donald 000039 Donald C. Robinson, D.D.S. 3709 Kecoughtan Rd. Hampton VA 23669 General <strong>Provider</strong> Hampton City<br />

Ross Edward 001469 Edward F. Ross, Jr., D.D.S., Ltd. 130 Thompson Street Ashland VA 23005 Orthodontist Hanover<br />

Shait Abraham 000310 Abraham Shait, D.D.S., Ltd. 7239 Mechanicsville Tpke. Mechanicsville VA 23111 Periodontist Hanover<br />

Khara Amanjot 001065 Amanjot Khara, D.D.S., P.C. 6372 Mechanicsville Tpke., Suite 106 Mechanicsville VA 23111 General <strong>Provider</strong> Hanover<br />

Ross Edward 001468 Edward F. Ross, Jr., D.D.S., Ltd. 7281 Hanover Green Drive Mechanicsville VA 23111 Orthodontist Hanover<br />

Lee Kyu 037532 K.J. Lee, D.M.D., PC 7347 Bell Creek Rd, Suite # 400 Mechanicsville VA 23111 General <strong>Provider</strong> Hanover<br />

* Jordan Morris 000299 Morris L Jordan DDS 7239 Mechanicsville Trnpk. Mechanicsville VA 23111 General <strong>Provider</strong> Hanover<br />

Murphy Walter 000306 Walter K. Murphy, D.D.S., P.C. 7009 Lee Park Rd. Mechanicsville VA 23111 Oral Surgeon Hanover<br />

English, II Sam 000018 Sam E English II DDS Ltd 8220 Windmill Watch Drive Mechanicsville VA 23116 General <strong>Provider</strong> Hanover<br />

Agnihotri Neil 000253 Virginia Oral & Facial Surgery 7481 Right Flank Road, Suite 120 Mechanicsville VA 23116 Oral Surgeon Hanover<br />

Dymon William 000253 Virginia Oral & Facial Surgery 7481 Right Flank Road, Suite 120 Mechanicsville VA 23116 Oral Surgeon Hanover<br />

Harris Monroe 000253 Virginia Oral & Facial Surgery 7481 Right Flank Road, Suite 120 Mechanicsville VA 23116 Oral Surgeon Hanover<br />

Keeney Kanyon 000253 Virginia Oral & Facial Surgery 7481 Right Flank Road, Suite 120 Mechanicsville VA 23116 Oral Surgeon Hanover<br />

Metzger Lawrence 000253 Virginia Oral & Facial Surgery 7481 Right Flank Road, Suite 120 Mechanicsville VA 23116 Oral Surgeon Hanover<br />

Watson Damon 000253 Virginia Oral & Facial Surgery 7481 Right Flank Road, Suite 120 Mechanicsville VA 23116 Oral Surgeon Hanover<br />

Damirchi Nasser 037683 Nasser Damirchi D.D.S., P.C. 5243 Hickory Park Dr, Suite D Glen Allen VA 23059 General <strong>Provider</strong> Henrico<br />

* Anderson Bradley 000300 Bradley R. Anderson, D.D.S. 11420 West Broad St. Glen Allen VA 23060 General <strong>Provider</strong> Henrico<br />

* Hackett, Jr. Charles 002542 Charles Hackett, Jr., D.D.S., P.C. 1807 Libbie Avenue, Suite 100 Richmond VA 23226 General <strong>Provider</strong> Henrico<br />

Garfield Dean 001984 Garfield Family Dentistry 5500 Monument Ave., Suite G Richmond VA 23226 General <strong>Provider</strong> Henrico<br />

Agnihotri Neil 037708 Virginia Oral & Facial Surgery 5224 Monument Ave, Suite 100 Richmond VA 23226 Oral Surgeon Henrico<br />

Alexander John 037708 Virginia Oral & Facial Surgery 5224 Monument Ave, Suite 100 Richmond VA 23226 Oral Surgeon Henrico<br />

Dymon William 037708 Virginia Oral & Facial Surgery 5224 Monument Ave, Suite 100 Richmond VA 23226 Oral Surgeon Henrico<br />

Harris Monroe 037708 Virginia Oral & Facial Surgery 5224 Monument Ave, Suite 100 Richmond VA 23226 Oral Surgeon Henrico<br />

Keeney Kanyon 037708 Virginia Oral & Facial Surgery 5224 Monument Ave, Suite 100 Richmond VA 23226 Oral Surgeon Henrico<br />

Metzger Lawrence 037708 Virginia Oral & Facial Surgery 5224 Monument Ave, Suite 100 Richmond VA 23226 Oral Surgeon Henrico<br />

Watson Damon 037708 Virginia Oral & Facial Surgery 5224 Monument Ave, Suite 100 Richmond VA 23226 Oral Surgeon Henrico<br />

Wlodawsky Ross 037708 Virginia Oral & Facial Surgery 5224 Monument Ave, Suite 100 Richmond VA 23226 Oral Surgeon Henrico<br />

* Jessup Ronald 000049 Ronald J. Jessup, D.D.S. 1130 Wilkinson Road Richmond VA 23227 General <strong>Provider</strong> Henrico<br />

Newberry William 000087 William L. Newberry, D.D.S. 1717 Bellevue Ave., Imperial Plaza Richmond VA 23227 General <strong>Provider</strong> Henrico<br />

Anderson Ralph 000014 George A. Oley, III, D.D.S. 9030 Three Chopt Road, Suite A Richmond VA 23229 Orthodontist Henrico<br />

Benson Wakeshi 000014 George A. Oley, III, D.D.S. 9030 Three Chopt Road, Suite A Richmond VA 23229 Orthodontist Henrico<br />

Hoover Amanda 000014 George A. Oley, III, D.D.S. 9030 Three Chopt Road, Suite A Richmond VA 23229 General <strong>Provider</strong> Henrico<br />

Ibrahim Karmen 000014 George A. Oley, III, D.D.S. 9030 Three Chopt Road, Suite A Richmond VA 23229 General <strong>Provider</strong> Henrico<br />

Kennealy Sarah 000014 George A. Oley, III, D.D.S. 9030 Three Chopt Road, Suite A Richmond VA 23229 General <strong>Provider</strong> Henrico<br />

Kopelove Stephen 000014 George A. Oley, III, D.D.S. 9030 Three Chopt Road, Suite A Richmond VA 23229 General <strong>Provider</strong> Henrico<br />

* Indicates dentist that is accepting current patients only.<br />

All <strong>Select</strong> <strong>Plan</strong> Dentists Page 48<br />

1 Same as a DHMO with fixed member copayments, no annual maximum dollar limits, no waiting periods, no deductibles, no pre-authorization paperwork or pre-treatment estimates and no<br />

claim forms or proof of loss (except in the case of out-of-area emergencies). Member must enroll with a General Dentist. Fac ID is used to indicate which facility a member chooses.


SELECT PLAN 1 DENTIST DIRECTORY<br />

Dentists listed are under contract as of 10/1/12<br />

Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />

Oley George 000014 George A. Oley, III, D.D.S. 9030 Three Chopt Road, Suite A Richmond VA 23229 General <strong>Provider</strong> Henrico<br />

Poquis Gregory 000014 George A. Oley, III, D.D.S. 9030 Three Chopt Road, Suite A Richmond VA 23229 General <strong>Provider</strong> Henrico<br />

Quilez Robert 000014 George A. Oley, III, D.D.S. 9030 Three Chopt Road, Suite A Richmond VA 23229 General <strong>Provider</strong> Henrico<br />

Wilby Lyla Rose 000014 George A. Oley, III, D.D.S. 9030 Three Chopt Road, Suite A Richmond VA 23229 General <strong>Provider</strong> Henrico<br />

Da Cunha Paul 002718 Paul Da Cunha DMD PC 8503 Patterson Ave, Suite C Richmond VA 23229 General <strong>Provider</strong> Henrico<br />

Stoner Kenneth 000040 Kenneth E. Stoner, D.D.S. & Associates 4922 W. Broad St., Westend Richmond VA 23230 General <strong>Provider</strong> Henrico<br />

Hendrickson-Hai Joelle 002614 Great Expressions, Jack Falvo, DDS 4859 Finlay Street Richmond VA 23231 General <strong>Provider</strong> Henrico<br />

Hudson Raidah 000015 Raidah Hudson, D.D.S., P.C. 4374 S. Laburnum Avenue Richmond VA 23231 General <strong>Provider</strong> Henrico<br />

* Osman Feisal 000766 Feisal Osman 3033 Lauderdale Drive Richmond VA 23233 General <strong>Provider</strong> Henrico<br />

* Hudson Paul 000047 Hudson & Hudson PC 1801 Raintree Dr, Suite A Richmond VA 23238 General <strong>Provider</strong> Henrico<br />

Shait Abraham 000309 Abraham Shait, D.D.S., Ltd. 3210 Skipwith Rd. Richmond VA 23294 Periodontist Henrico<br />

Agnihotri Neil 000251 Virginia Oral & Facial Surgery 7650 Parham Rd., Suite 110 Richmond VA 23294 Oral Surgeon Henrico<br />

Alexander John 000251 Virginia Oral & Facial Surgery 7650 Parham Rd., Suite 110 Richmond VA 23294 Oral Surgeon Henrico<br />

Dymon William 000251 Virginia Oral & Facial Surgery 7650 Parham Rd., Suite 110 Richmond VA 23294 Oral Surgeon Henrico<br />

Harris Monroe 000251 Virginia Oral & Facial Surgery 7650 Parham Rd., Suite 110 Richmond VA 23294 Oral Surgeon Henrico<br />

Keeney Kanyon 000251 Virginia Oral & Facial Surgery 7650 Parham Rd., Suite 110 Richmond VA 23294 Oral Surgeon Henrico<br />

Metzger Lawrence 000251 Virginia Oral & Facial Surgery 7650 Parham Rd., Suite 110 Richmond VA 23294 Oral Surgeon Henrico<br />

Watson Damon 000251 Virginia Oral & Facial Surgery 7650 Parham Rd., Suite 110 Richmond VA 23294 Oral Surgeon Henrico<br />

Agnihotri Neil 000252 Virginia Oral & Facial Surgery 5510 Whiteside Dr Sandston VA 23150 Oral Surgeon Henrico<br />

Alexander John 000252 Virginia Oral & Facial Surgery 5510 Whiteside Dr Sandston VA 23150 Oral Surgeon Henrico<br />

Dymon William 000252 Virginia Oral & Facial Surgery 5510 Whiteside Dr Sandston VA 23150 Oral Surgeon Henrico<br />

Harris Monroe 000252 Virginia Oral & Facial Surgery 5510 Whiteside Dr Sandston VA 23150 Oral Surgeon Henrico<br />

Keeney Kanyon 000252 Virginia Oral & Facial Surgery 5510 Whiteside Dr Sandston VA 23150 Oral Surgeon Henrico<br />

Metzger Lawrence 000252 Virginia Oral & Facial Surgery 5510 Whiteside Dr Sandston VA 23150 Oral Surgeon Henrico<br />

Watson Damon 000252 Virginia Oral & Facial Surgery 5510 Whiteside Dr Sandston VA 23150 Oral Surgeon Henrico<br />

Avram Adrian 000019 Sam E English II DDS Ltd 5303 Plaza Drive, Suite 103 Hopewell VA 23860 General <strong>Provider</strong> Hopewell City<br />

English, II Sam 000019 Sam E English II DDS Ltd 5303 Plaza Drive, Suite 103 Hopewell VA 23860 General <strong>Provider</strong> Hopewell City<br />

Nguyen Kim 000019 Sam E English II DDS Ltd 5303 Plaza Drive, Suite 103 Hopewell VA 23860 General <strong>Provider</strong> Hopewell City<br />

English, II Sam 002647 Sam E English II DDS LLC 4680-16A Monticello Ave. Williamsburg VA 23188 General <strong>Provider</strong> James City<br />

Raphael Jeff 002647 Sam E English II DDS LLC 4680-16A Monticello Ave. Williamsburg VA 23188 General <strong>Provider</strong> James City<br />

Rhyne Katherine 002647 Sam E English II DDS LLC 4680-16A Monticello Ave. Williamsburg VA 23188 General <strong>Provider</strong> James City<br />

Coker John 050331 John H Coker Jr DMD 9449 Grover Dr, 100 King George VA 22485 Orthodontist King George<br />

English, II Sam 000009 Sam E English II DDS Ltd 628 Main St. West Point VA 23181 General <strong>Provider</strong> King William<br />

Raphael Jeff 000009 Sam E English II DDS Ltd 628 Main St. West Point VA 23181 General <strong>Provider</strong> King William<br />

Eghtessad Mohammed 037695 Gateway <strong>Dental</strong> 44330 Premier Plaza, 140 Ashburn VA 20147 General <strong>Provider</strong> Loudoun<br />

Chaddad Karim 070969 Gateway <strong>Dental</strong> Specialists 44330 Premier Plaza, Suite 140 Ashburn VA 20147 Periodontist Loudoun<br />

Patel Ajit 050882 Ashburn Pediatric <strong>Dental</strong> Center 42882 Truro Parish Dr, Suite 205 Ashburn VA 20148 Pedodontist Loudoun<br />

Longwe Edward 051024 Dulles Oral Surgical Center 24805 Pinebrook Rd, Suite 100 Chantilly VA 20152 Oral Surgeon Loudoun<br />

Omar Anisa 050363 East Gate Orthodontics 25401 Eastern Marketplace Plz, Suite 195 Chantilly VA 20152 Orthodontist Loudoun<br />

Amin Ahmad 037730 South Riding <strong>Dental</strong> Associates, P.C. 25055 Riding Plaza Dr., Suite 270 Chantilly VA 20152 Oral Surgeon Loudoun<br />

Hukmani Navin 037730 South Riding <strong>Dental</strong> Associates, P.C. 25055 Riding Plaza Dr., Suite 270 Chantilly VA 20152 Orthodontist Loudoun<br />

Huynh Thuylinh 037730 South Riding <strong>Dental</strong> Associates, P.C. 25055 Riding Plaza Dr., Suite 270 Chantilly VA 20152 Orthodontist Loudoun<br />

Valleru Silvija 037730 South Riding <strong>Dental</strong> Associates, P.C. 25055 Riding Plaza Dr., Suite 270 Chantilly VA 20152 General <strong>Provider</strong> Loudoun<br />

Zeiaei-Nafchi Saeid 037730 South Riding <strong>Dental</strong> Associates, P.C. 25055 Riding Plaza Dr., Suite 270 Chantilly VA 20152 General <strong>Provider</strong> Loudoun<br />

Rafaat Amirreza 002290 Amirreza Rafaat, D.D.S., P.C. 19450 Deerfield Avenue, Suite 465 Lansdowne VA 20176 General <strong>Provider</strong> Loudoun<br />

Lee Richard 050489 Loudoun Orthodontics 19465 Deerfield Ave, Suite 304 Lansdowne VA 20176 Orthodontist Loudoun<br />

Shojaei Mariah 002091 Mariah Shojaei, D.M.D. 46161 West Lake Drive, #120 Potomac Falls VA 20165 Endodontist Loudoun<br />

Alayssami Mazin 000157 Bright Now <strong>Dental</strong> 6 Pidgeon Hill Dr., Suite 200 Sterling VA 20165 General <strong>Provider</strong> Loudoun<br />

Eghtessad Mohammed 000157 Bright Now <strong>Dental</strong> 6 Pidgeon Hill Dr., Suite 200 Sterling VA 20165 General <strong>Provider</strong> Loudoun<br />

Nallavalli Sravanthi 000157 Bright Now <strong>Dental</strong> 6 Pidgeon Hill Dr., Suite 200 Sterling VA 20165 General <strong>Provider</strong> Loudoun<br />

Parvathaneni Bhavani 000157 Bright Now <strong>Dental</strong> 6 Pidgeon Hill Dr., Suite 200 Sterling VA 20165 General <strong>Provider</strong> Loudoun<br />

Reedy Hima-Bindu 000157 Bright Now <strong>Dental</strong> 6 Pidgeon Hill Dr., Suite 200 Sterling VA 20165 General <strong>Provider</strong> Loudoun<br />

Hooshmand Marie 001808 Marie Hooshmand, D.D.S., P.C. 21165 Whitfield Place, Suite 101 Sterling VA 20165 General <strong>Provider</strong> Loudoun<br />

Chaddad Karim 050929 Mazin Alayssami DMD & Associates PC Specialists 6 Pidgeon Hill Dr, Suite 200 Sterling VA 20165 Periodontist Loudoun<br />

Bidgoli Rashin 001937 Rashin T. Bidgoli, D.D.S. 21145 Whitfield Place, #101 Sterling VA 20165 Endodontist Loudoun<br />

Tolba Mostafa 001937 Rashin T. Bidgoli, D.D.S. 21145 Whitfield Place, #101 Sterling VA 20165 Endodontist Loudoun<br />

Duong Truc 001912 Truc Duong, D.D.S., PC 21145 Whitfield Pl., Suite 103 Sterling VA 20165 General <strong>Provider</strong> Loudoun<br />

Alathari Humam 002058 Zina Alathari, D.M.D. 21155 Whitfield Place, Suite 106 Sterling VA 20165 General <strong>Provider</strong> Loudoun<br />

Alathari Zina 002058 Zina Alathari, D.M.D. 21155 Whitfield Place, Suite 106 Sterling VA 20165 General <strong>Provider</strong> Loudoun<br />

Frankenberry Anishka 078262 Stone Ridge Orthodontics 24600 Millstream Drive, Suite 101 Stone Ridge VA 20105 Orthodontist Loudoun<br />

Amin Ahmad 001729 <strong>Dental</strong> One Associates Manassas PC 7800 Sudley Rd., Suite 7810 Manassas VA 20109 Oral Surgeon Manassas City<br />

Hukmani Navin 001729 <strong>Dental</strong> One Associates Manassas PC 7800 Sudley Rd., Suite 7810 Manassas VA 20109 Orthodontist Manassas City<br />

Khosravi Mitra 001729 <strong>Dental</strong> One Associates Manassas PC 7800 Sudley Rd., Suite 7810 Manassas VA 20109 General <strong>Provider</strong> Manassas City<br />

Rasmussen James 002066 James E. Rasmussen, D.M.D., PC 10600 Crestwood Dr. Manassas VA 20109 Oral Surgeon Manassas City<br />

Ali Ziad 002760 Manassas <strong>Dental</strong> Associates, PC Specialists 10630-B Crestwood Drive Manassas VA 20109 Oral Surgeon Manassas City<br />

Traboulsi Georges 002760 Manassas <strong>Dental</strong> Associates, PC Specialists 10630-B Crestwood Drive Manassas VA 20109 Periodontist Manassas City<br />

* Indicates dentist that is accepting current patients only.<br />

All <strong>Select</strong> <strong>Plan</strong> Dentists Page 49<br />

1 Same as a DHMO with fixed member copayments, no annual maximum dollar limits, no waiting periods, no deductibles, no pre-authorization paperwork or pre-treatment estimates and no<br />

claim forms or proof of loss (except in the case of out-of-area emergencies). Member must enroll with a General Dentist. Fac ID is used to indicate which facility a member chooses.


SELECT PLAN 1 DENTIST DIRECTORY<br />

Dentists listed are under contract as of 10/1/12<br />

Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />

Sina Nadia 037649 MY BRACES DOCTOR, PC 10630 Crestwood Dr., Suite A Manassas VA 20109 Orthodontist Manassas City<br />

Biscombe Terrence 050778 Kevin Mendes DDS & Associates PLLC 8404 Dorsey Circle Manassas VA 20110 General <strong>Provider</strong> Manassas City<br />

Guo Juanli 050778 Kevin Mendes DDS & Associates PLLC 8404 Dorsey Circle Manassas VA 20110 General <strong>Provider</strong> Manassas City<br />

Huang Dan 050778 Kevin Mendes DDS & Associates PLLC 8404 Dorsey Circle Manassas VA 20110 General <strong>Provider</strong> Manassas City<br />

Le Tuan 050778 Kevin Mendes DDS & Associates PLLC 8404 Dorsey Circle Manassas VA 20110 General <strong>Provider</strong> Manassas City<br />

Lee Philip 050778 Kevin Mendes DDS & Associates PLLC 8404 Dorsey Circle Manassas VA 20110 General <strong>Provider</strong> Manassas City<br />

Mattern Johnson Mandy 050778 Kevin Mendes DDS & Associates PLLC 8404 Dorsey Circle Manassas VA 20110 General <strong>Provider</strong> Manassas City<br />

Mendes Kevin 050778 Kevin Mendes DDS & Associates PLLC 8404 Dorsey Circle Manassas VA 20110 Orthodontist Manassas City<br />

Mendes Kevin 050777 Kevin Mendes DDS & Associates PLLC 8609 Sudley Road, Suite 102 Manassas VA 20110 Orthodontist Manassas City<br />

Rejintala Archana 050778 Kevin Mendes DDS & Associates PLLC 8404 Dorsey Circle Manassas VA 20110 General <strong>Provider</strong> Manassas City<br />

Rusznak Zoltan 050778 Kevin Mendes DDS & Associates PLLC 8404 Dorsey Circle Manassas VA 20110 General <strong>Provider</strong> Manassas City<br />

Schlank Eugene 050778 Kevin Mendes DDS & Associates PLLC 8404 Dorsey Circle Manassas VA 20110 General <strong>Provider</strong> Manassas City<br />

Shumate Kenneth 050778 Kevin Mendes DDS & Associates PLLC 8404 Dorsey Circle Manassas VA 20110 General <strong>Provider</strong> Manassas City<br />

Hussaini Syed 069576 Syed K Hussaini DDS 10081 Market Cir Manassas VA 20110 Orthodontist Manassas City<br />

Montalvan Cesar 002704 MP <strong>Dental</strong> Associates, D.D.S, PC 7806 Centerville Rd. Manassas Park VA 20111 General <strong>Provider</strong> Manassas City<br />

* Chung John 000023 John Chung Family Dentistry 13626 Warwick Blvd., Suite A Newport News VA 23602 General <strong>Provider</strong> Newport News City<br />

Kaplan Marvin 000134 Marvin Kaplan, D.D.S., Ltd. 13193 Warwick Boulevard Newport News VA 23602 Orthodontist Newport News City<br />

* Katz Ronald 002885 Warwick <strong>Dental</strong> Center 12420 Warwick Blvd., Suite 1-A Newport News VA 23606 General <strong>Provider</strong> Newport News City<br />

Hirschler David 001219 Periodontology Associates 5900 E VA Beach Blvd, 213 Janaf Office Bldg Norfolk VA 23502 Periodontist Norfolk City<br />

Witte Ernest 001219 Periodontology Associates 5900 E VA Beach Blvd, 213 Janaf Office Bldg Norfolk VA 23502 Periodontist Norfolk City<br />

Reynolds Jillian 078270 LWSS Dentistry for Children 302 East Little Creek Road, Suite B Norfolk VA 23505 Pedodontist Norfolk City<br />

Sachs Scott 078270 LWSS Dentistry for Children 302 East Little Creek Road, Suite B Norfolk VA 23505 Pedodontist Norfolk City<br />

Ashby John 002867 Owens and Dorfman, LTD 7400 Granby Street Norfolk VA 23505 Orthodontist Norfolk City<br />

Dailey Curtis 002867 Owens and Dorfman, LTD 7400 Granby Street Norfolk VA 23505 Orthodontist Norfolk City<br />

Esparza Sarah 000037 Rita Frazier, D.D.S. 136 E. Little Creek Rd. Norfolk VA 23505 General <strong>Provider</strong> Norfolk City<br />

Frazier Rita 000037 Rita Frazier, D.D.S. 136 E. Little Creek Rd. Norfolk VA 23505 General <strong>Provider</strong> Norfolk City<br />

Howell Robert 000072 Robert W. Howell, D.D.S. 110 Kingsley Lane, Suite 312 Norfolk VA 23505 General <strong>Provider</strong> Norfolk City<br />

Conelias Trent 002841 Trent P. Conelias, DDS 110 Kingsley Lane Norfolk VA 23505 Oral Surgeon Norfolk City<br />

Morrison Sanford 000720 S.Neil Morrison DDS, & Melvin R. Morrison,DDS 204 Medical Tower Norfolk VA 23507 Oral Surgeon Norfolk City<br />

Spain Murray 002678 Murray Spain, D.M.D. 1216 Granby St., Ste. 2 Norfolk VA 23510 General <strong>Provider</strong> Norfolk City<br />

Katz Ronald 002876 Tidewater <strong>Dental</strong> Center, PLLC 425 West 20th St., Suite 3 Norfolk VA 23517 General <strong>Provider</strong> Norfolk City<br />

Reynolds Kenneth 002876 Tidewater <strong>Dental</strong> Center, PLLC 425 West 20th St., Suite 3 Norfolk VA 23517 General <strong>Provider</strong> Norfolk City<br />

Griffin Charles 000098 Charles F. Griffin, D.D.S. 3277 South Crater Rd. Petersburg VA 23805 General <strong>Provider</strong> Petersburg City<br />

Jenkins Harry 000341 Jenkins <strong>Dental</strong> Group 3349 Portsmouth Blvd. Portsmouth VA 23701 General <strong>Provider</strong> Portsmouth City<br />

Sweeney Richard 051038 <strong>Dominion</strong> Dentistry PLLC 3219 Stamford Rd Portsmouth VA 23703 General <strong>Provider</strong> Portsmouth City<br />

Martin J B 000259 Friendly Faces Pediatric Dentistry 446 Effingham St Portsmouth VA 23704 Pedodontist Portsmouth City<br />

Green, Jr. Roosevelt 000073 Roosevelt T. Green, Jr.,D.D.S. 600 S. Green St. Portsmouth VA 23704 General <strong>Provider</strong> Portsmouth City<br />

Althouse Elliott 050822 Drs. Althouse, Carroll and Alperin 3410 County St. Portsmouth VA 23707 General <strong>Provider</strong> Portsmouth City<br />

* Reynolds Kenneth 002161 K. Bradley Reynolds, D.D.S. 1307 Airline Blvd. Portsmouth VA 23707 General <strong>Provider</strong> Portsmouth City<br />

Stevenson Pretlow 000322 Pretlow Stevenson, Jr., D.D.S. 3412 Columbia St. Portsmouth VA 23707 General <strong>Provider</strong> Portsmouth City<br />

* Hanania Hanna 002416 Hanna Hannania, D.D.S., P.C. 4319 Dale Blvd. Dale City VA 22193 General <strong>Provider</strong> Prince William<br />

Falaiye Victor 051112 The Dentist Office LLC 17865 Main St, Suite A Dumfries VA 22026 General <strong>Provider</strong> Prince William<br />

Zhu Xinsheng 037668 Zhu Orthodontics 17606 Main St., Suite 200 Dumfries VA 22026 Orthodontist Prince William<br />

Filippone Louis 050564 Louis C Filippone DDS PC 7521 Virginia Oaks Dr, Suite 120 Gainesville VA 20155 Orthodontist Prince William<br />

Ekoh Madueke 037737 Teem Orthodontics PLLC 14634 Lee Highway Gainesville VA 20155 Orthodontist Prince William<br />

Gutmann J. 000587 J. Steven Gutmann, D.D.S., P.C. 1910 Opitz Blvd. Woodbridge VA 22191 Oral Surgeon Prince William<br />

Patel Mayur 081562 Light Family <strong>Dental</strong> 14416 Jefferson Davis Hwy, Suite 16 Woodbridge VA 22191 General <strong>Provider</strong> Prince William<br />

Cantor David 002654 Northern Virginia Oral & Maxillofacial Surgery 2020-A Optiz Blvd., Suite A Woodbridge VA 22191 Oral Surgeon Prince William<br />

Francioni Sonia 002654 Northern Virginia Oral & Maxillofacial Surgery 2020-A Optiz Blvd., Suite A Woodbridge VA 22191 Oral Surgeon Prince William<br />

LaBriola J. Daniel 002654 Northern Virginia Oral & Maxillofacial Surgery 2020-A Optiz Blvd., Suite A Woodbridge VA 22191 Oral Surgeon Prince William<br />

Zadeh Hugh 002654 Northern Virginia Oral & Maxillofacial Surgery 2020-A Optiz Blvd., Suite A Woodbridge VA 22191 Oral Surgeon Prince William<br />

Alathari Humam 050894 Potomac <strong>Dental</strong> Center 1912 Opitz Blvd Woodbridge VA 22191 General <strong>Provider</strong> Prince William<br />

Pham Gina 038096 BriteStars Pediatric Dentistry PLLC 12602 Lake Ridge Dr Woodbridge VA 22192 Pedodontist Prince William<br />

Frankenberry Anishka 050642 Bruce Taheri DDS PC Orthodontist 3114 Golansky Blvd., Suite 102 Woodbridge VA 22192 Orthodontist Prince William<br />

Ali Ziad 002761 Bruce Taheri, DDS, PC Specialists 3114 Golansky Blvd., #102 Woodbridge VA 22192 Oral Surgeon Prince William<br />

Traboulsi Georges 002761 Bruce Taheri, DDS, PC Specialists 3114 Golansky Blvd., #102 Woodbridge VA 22192 Periodontist Prince William<br />

Doan Thao 002131 <strong>Dental</strong> Center at Lake Ridge 12764 Darby Brooke Ct. Woodbridge VA 22192 General <strong>Provider</strong> Prince William<br />

Braunfeld Joel 000456 Joel R Braunfeld DDS 2239-L Tackett's Mill Dr. Woodbridge VA 22192 General <strong>Provider</strong> Prince William<br />

Saleh Fadi 050883 Lake Ridge Orthodontics PC 12662 A Lake Ridge Dr, Suite A Woodbridge VA 22192 Orthodontist Prince William<br />

Pell James 038079 Oral Surgery Associates of Northern Virginia Ltd 3158 Golansky Blvd, Suite 102 Woodbridge VA 22192 Oral Surgeon Prince William<br />

Wang Richard 038079 Oral Surgery Associates of Northern Virginia Ltd 3158 Golansky Blvd, Suite 102 Woodbridge VA 22192 Oral Surgeon Prince William<br />

Le Kathy 051029 Sameer Kwatra DDS PC Specialists 2970 Prince William Pwky Woodbridge VA 22192 Endodontist Prince William<br />

Colina Kevin 033879 Sameer Kwatra, D.D.S., PC 2970 Prince William Pkwy Woodbridge VA 22192 General <strong>Provider</strong> Prince William<br />

Dulabh Mita 033879 Sameer Kwatra, D.D.S., PC 2970 Prince William Pkwy Woodbridge VA 22192 General <strong>Provider</strong> Prince William<br />

Kwatra Sameer 033879 Sameer Kwatra, D.D.S., PC 2970 Prince William Pkwy Woodbridge VA 22192 General <strong>Provider</strong> Prince William<br />

Amin Ahmad 001731 Woodbridge <strong>Dental</strong> Associates P.C. 14520 Smoketown Rd. Woodbridge VA 22192 Oral Surgeon Prince William<br />

* Indicates dentist that is accepting current patients only.<br />

All <strong>Select</strong> <strong>Plan</strong> Dentists Page 50<br />

1 Same as a DHMO with fixed member copayments, no annual maximum dollar limits, no waiting periods, no deductibles, no pre-authorization paperwork or pre-treatment estimates and no<br />

claim forms or proof of loss (except in the case of out-of-area emergencies). Member must enroll with a General Dentist. Fac ID is used to indicate which facility a member chooses.


SELECT PLAN 1 DENTIST DIRECTORY<br />

Dentists listed are under contract as of 10/1/12<br />

Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />

Hukmani Navin 001731 Woodbridge <strong>Dental</strong> Associates P.C. 14520 Smoketown Rd. Woodbridge VA 22192 Orthodontist Prince William<br />

Valleru Silvija 001731 Woodbridge <strong>Dental</strong> Associates P.C. 14520 Smoketown Rd. Woodbridge VA 22192 General <strong>Provider</strong> Prince William<br />

Zeiaei-Nafchi Saeid 001731 Woodbridge <strong>Dental</strong> Associates P.C. 14520 Smoketown Rd. Woodbridge VA 22192 General <strong>Provider</strong> Prince William<br />

Nguyen Phuong 078278 Woodbridge Oral and Maxillofacial Surgery Center 4585 Daisy Reid Avenue, Suite 105 Woodbridge VA 22192 Oral Surgeon Prince William<br />

* Haston Raymond 000451 Raymond C. Haston, Jr., D.D.S. 14393 Hereford Road Woodbridge VA 22193 General <strong>Provider</strong> Prince William<br />

Morrison Julius 000059 Julius V. Morrison, D.D.S. 530 E Main St., Suite 400 Richmond VA 23219 General <strong>Provider</strong> Richmond City<br />

Exum Antone 079793 Antone Exum DDS 505 W Leight Street, Suite 106 Richmond VA 23220 General <strong>Provider</strong> Richmond City<br />

Adams Randy 000142 Dentistry for Children 300 W. Broad Street Richmond VA 23220 Pedodontist Richmond City<br />

* Jones John 000064 John W. Jones, D.D.S. 1805 Monument Ave., Suite 501 Richmond VA 23220 General <strong>Provider</strong> Richmond City<br />

English, II Sam 002669 Sam E English II DDS LLC 3500 Grove Ave. Richmond VA 23221 General <strong>Provider</strong> Richmond City<br />

Musetti Christopher 002669 Sam E English II DDS LLC 3500 Grove Ave. Richmond VA 23221 General <strong>Provider</strong> Richmond City<br />

Roberts Cameron 002669 Sam E English II DDS LLC 3500 Grove Ave. Richmond VA 23221 General <strong>Provider</strong> Richmond City<br />

Grantham Tabbitha 038060 Grantham Family Dentistry 1122 N 25th St, Suite E Richmond VA 23223 General <strong>Provider</strong> Richmond City<br />

Morrison Julius 001930 Vernon J. Harris East End Community Health Center 719 N. 25th St., 2nd Floor Richmond VA 23223 General <strong>Provider</strong> Richmond City<br />

Byrd Richard 000168 Richard L. Byrd, D.D.S. 101 Cowardin Ave., #306-A Richmond VA 23224 Orthodontist Richmond City<br />

Cade Ronald 001584 Ronald E Cade <strong>Inc</strong> 101 Cowardin Avenue, Suite 206 Richmond VA 23224 Prosthodontist Richmond City<br />

* Puller Anthony 000010 Anthony J Puller DDS 7834 Forest Hill Ave., Suite 6 Richmond VA 23225 General <strong>Provider</strong> Richmond City<br />

Lilly, Jr. J. David 000012 J David Lilly Jr DDS 7834 Forest Hill Avenue Richmond VA 23225 General <strong>Provider</strong> Richmond City<br />

Byrd Richard 000135 Richard L. Byrd, D.D.S., Ltd. 6740 Forest Hill Avenue, Suite 103 Richmond VA 23225 Orthodontist Richmond City<br />

Abubaker A Omar 001699 Dentistry@VCU 521 North 11th Street Richmond VA 23298 Oral Surgeon Richmond City<br />

DeLuke Dean 001699 Dentistry@VCU 521 North 11th Street Richmond VA 23298 Oral Surgeon Richmond City<br />

Desai Bhavik 001699 Dentistry@VCU 521 North 11th Street Richmond VA 23298 Oral Surgeon Richmond City<br />

Giglio James 001699 Dentistry@VCU 521 North 11th Street Richmond VA 23298 Oral Surgeon Richmond City<br />

Huband Michael 001699 Dentistry@VCU 521 North 11th Street Richmond VA 23298 Prosthodontist Richmond City<br />

Laskin Daniel 001699 Dentistry@VCU 521 North 11th Street Richmond VA 23298 Oral Surgeon Richmond City<br />

Lui David 001699 Dentistry@VCU 521 North 11th Street Richmond VA 23298 Oral Surgeon Richmond City<br />

Smagalski Gary 001699 Dentistry@VCU 521 North 11th Street Richmond VA 23298 Oral Surgeon Richmond City<br />

Strauss Robert 001699 Dentistry@VCU 521 North 11th Street Richmond VA 23298 Oral Surgeon Richmond City<br />

Terrill David 001068 David Terrill, D.D.S. 11113 Leavells Rd. Fredericksburg VA 22407 Orthodontist Spotsylvania<br />

Romano Frank 000147 Frank D. Romano, D.D.S. 1133 Heatherstone Dr. Fredericksburg VA 22407 General <strong>Provider</strong> Spotsylvania<br />

Byrd Richard 002743 Fredericksburg Pediatric Dentistry 927 Maple Grove Drive, Suite 111 Fredericksburg VA 22407 Orthodontist Spotsylvania<br />

Sina Nadia 037650 MY BRACES DOCTOR, PC 4300 <strong>Plan</strong>k Rd., Suite 230 Fredericksburg VA 22407 Orthodontist Spotsylvania<br />

Pagan Robert 001206 R. David Pagan, D.M.D., P.C. 4224 <strong>Plan</strong>k Rd., Ste.B Fredericksburg VA 22407 Endodontist Spotsylvania<br />

Abuhajleh Omar 037958 Bright Now <strong>Dental</strong> 10454 Hill Top Plaza Way Spotsylvania VA 22553 General <strong>Provider</strong> Spotsylvania<br />

Alayssami Mazin 037958 Bright Now <strong>Dental</strong> 10454 Hill Top Plaza Way Spotsylvania VA 22553 General <strong>Provider</strong> Spotsylvania<br />

Byrd Richard 037958 Bright Now <strong>Dental</strong> 10454 Hill Top Plaza Way Spotsylvania VA 22553 Orthodontist Spotsylvania<br />

Khalaf Athra 037958 Bright Now <strong>Dental</strong> 10454 Hill Top Plaza Way Spotsylvania VA 22553 General <strong>Provider</strong> Spotsylvania<br />

Malghan Nandini 037958 Bright Now <strong>Dental</strong> 10454 Hill Top Plaza Way Spotsylvania VA 22553 General <strong>Provider</strong> Spotsylvania<br />

Coker John 000726 John H Coker Jr DMD 10472 Georgetown Drive Spotsylvania VA 22553 Orthodontist Spotsylvania<br />

* Haston Raymond 000428 Raymond C Haston Jr DDS PC 560 Celebrate Virginia Pkwy, 107 Fredericksburg VA 22406 General <strong>Provider</strong> Stafford<br />

Alayssami Mazin 000156 Bright Now <strong>Dental</strong> 392 Garrisonville Rd., Suite 205 Stafford VA 22554 General <strong>Provider</strong> Stafford<br />

Byrd Richard 000156 Bright Now <strong>Dental</strong> 392 Garrisonville Rd., Suite 205 Stafford VA 22554 Orthodontist Stafford<br />

Elgazzar Mohamed 000156 Bright Now <strong>Dental</strong> 392 Garrisonville Rd., Suite 205 Stafford VA 22554 General <strong>Provider</strong> Stafford<br />

Niepraschk Markus 000156 Bright Now <strong>Dental</strong> 392 Garrisonville Rd., Suite 205 Stafford VA 22554 Orthodontist Stafford<br />

Palle Sunitha 000156 Bright Now <strong>Dental</strong> 392 Garrisonville Rd., Suite 205 Stafford VA 22554 General <strong>Provider</strong> Stafford<br />

Attreed Elizabeth 000854 Elizabeth M Attreed DDS 2832 Jefferson Davis Hwy, Aquia Towne Center Stafford VA 22554 General <strong>Provider</strong> Stafford<br />

Coker John 000842 John H Coker Jr DMD 239 Garrisonville Rd., Suite 101 Stafford VA 22554 Orthodontist Stafford<br />

Chaddad Karim 050930 Mazin Alayssami DMD & Associates PC Specialists 392 Garrisonville Rd, Suite 205 Stafford VA 22554 Periodontist Stafford<br />

Patel Ashish 050930 Mazin Alayssami DMD & Associates PC Specialists 392 Garrisonville Rd, Suite 205 Stafford VA 22554 Oral Surgeon Stafford<br />

* Abdelwahab Tamer 050724 Konikoff <strong>Dental</strong> Associates 5849 Harbour View Blvd, Suite 100 Suffolk VA 23435 General <strong>Provider</strong> Suffolk City<br />

* Ansari Uzma 050724 Konikoff <strong>Dental</strong> Associates 5849 Harbour View Blvd, Suite 100 Suffolk VA 23435 General <strong>Provider</strong> Suffolk City<br />

* Berrada Sanae 050724 Konikoff <strong>Dental</strong> Associates 5849 Harbour View Blvd, Suite 100 Suffolk VA 23435 General <strong>Provider</strong> Suffolk City<br />

* Bozman Jenny 050724 Konikoff <strong>Dental</strong> Associates 5849 Harbour View Blvd, Suite 100 Suffolk VA 23435 General <strong>Provider</strong> Suffolk City<br />

* Chawla Seema 050724 Konikoff <strong>Dental</strong> Associates 5849 Harbour View Blvd, Suite 100 Suffolk VA 23435 General <strong>Provider</strong> Suffolk City<br />

* Dobson Roberta 050724 Konikoff <strong>Dental</strong> Associates 5849 Harbour View Blvd, Suite 100 Suffolk VA 23435 General <strong>Provider</strong> Suffolk City<br />

* Dobson, III Joseph 050724 Konikoff <strong>Dental</strong> Associates 5849 Harbour View Blvd, Suite 100 Suffolk VA 23435 General <strong>Provider</strong> Suffolk City<br />

* Elosta Wael 050724 Konikoff <strong>Dental</strong> Associates 5849 Harbour View Blvd, Suite 100 Suffolk VA 23435 General <strong>Provider</strong> Suffolk City<br />

* Field Marcus 050724 Konikoff <strong>Dental</strong> Associates 5849 Harbour View Blvd, Suite 100 Suffolk VA 23435 General <strong>Provider</strong> Suffolk City<br />

* Field Sheila 050724 Konikoff <strong>Dental</strong> Associates 5849 Harbour View Blvd, Suite 100 Suffolk VA 23435 General <strong>Provider</strong> Suffolk City<br />

* Gioffre Mollie 050724 Konikoff <strong>Dental</strong> Associates 5849 Harbour View Blvd, Suite 100 Suffolk VA 23435 General <strong>Provider</strong> Suffolk City<br />

* Hoek Meredith 050724 Konikoff <strong>Dental</strong> Associates 5849 Harbour View Blvd, Suite 100 Suffolk VA 23435 General <strong>Provider</strong> Suffolk City<br />

* Jones Daniel 050724 Konikoff <strong>Dental</strong> Associates 5849 Harbour View Blvd, Suite 100 Suffolk VA 23435 General <strong>Provider</strong> Suffolk City<br />

* Konikoff David 050724 Konikoff <strong>Dental</strong> Associates 5849 Harbour View Blvd, Suite 100 Suffolk VA 23435 General <strong>Provider</strong> Suffolk City<br />

* Lanigan Jacqueline 050724 Konikoff <strong>Dental</strong> Associates 5849 Harbour View Blvd, Suite 100 Suffolk VA 23435 General <strong>Provider</strong> Suffolk City<br />

* Maclin Ivetta 050724 Konikoff <strong>Dental</strong> Associates 5849 Harbour View Blvd, Suite 100 Suffolk VA 23435 General <strong>Provider</strong> Suffolk City<br />

* Mady Zeyad 050724 Konikoff <strong>Dental</strong> Associates 5849 Harbour View Blvd, Suite 100 Suffolk VA 23435 General <strong>Provider</strong> Suffolk City<br />

* Indicates dentist that is accepting current patients only.<br />

All <strong>Select</strong> <strong>Plan</strong> Dentists Page 51<br />

1 Same as a DHMO with fixed member copayments, no annual maximum dollar limits, no waiting periods, no deductibles, no pre-authorization paperwork or pre-treatment estimates and no<br />

claim forms or proof of loss (except in the case of out-of-area emergencies). Member must enroll with a General Dentist. Fac ID is used to indicate which facility a member chooses.


SELECT PLAN 1 DENTIST DIRECTORY<br />

Dentists listed are under contract as of 10/1/12<br />

Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />

* Maniwang Jo-Marie 050724 Konikoff <strong>Dental</strong> Associates 5849 Harbour View Blvd, Suite 100 Suffolk VA 23435 General <strong>Provider</strong> Suffolk City<br />

* Mattioli Michele 050724 Konikoff <strong>Dental</strong> Associates 5849 Harbour View Blvd, Suite 100 Suffolk VA 23435 General <strong>Provider</strong> Suffolk City<br />

* McCarty Benjamin 050724 Konikoff <strong>Dental</strong> Associates 5849 Harbour View Blvd, Suite 100 Suffolk VA 23435 General <strong>Provider</strong> Suffolk City<br />

* Miranda Joshua 050724 Konikoff <strong>Dental</strong> Associates 5849 Harbour View Blvd, Suite 100 Suffolk VA 23435 General <strong>Provider</strong> Suffolk City<br />

* Morris Mason-Leigh 050724 Konikoff <strong>Dental</strong> Associates 5849 Harbour View Blvd, Suite 100 Suffolk VA 23435 General <strong>Provider</strong> Suffolk City<br />

* Muldoon Catherine 050724 Konikoff <strong>Dental</strong> Associates 5849 Harbour View Blvd, Suite 100 Suffolk VA 23435 General <strong>Provider</strong> Suffolk City<br />

* Parker Richard 050724 Konikoff <strong>Dental</strong> Associates 5849 Harbour View Blvd, Suite 100 Suffolk VA 23435 General <strong>Provider</strong> Suffolk City<br />

* Pearl Dina 050724 Konikoff <strong>Dental</strong> Associates 5849 Harbour View Blvd, Suite 100 Suffolk VA 23435 General <strong>Provider</strong> Suffolk City<br />

* Reichley John 050724 Konikoff <strong>Dental</strong> Associates 5849 Harbour View Blvd, Suite 100 Suffolk VA 23435 General <strong>Provider</strong> Suffolk City<br />

* Richards Damdy 050724 Konikoff <strong>Dental</strong> Associates 5849 Harbour View Blvd, Suite 100 Suffolk VA 23435 General <strong>Provider</strong> Suffolk City<br />

* Santos Estelito 050724 Konikoff <strong>Dental</strong> Associates 5849 Harbour View Blvd, Suite 100 Suffolk VA 23435 General <strong>Provider</strong> Suffolk City<br />

* Solarte-Castro Edith 050724 Konikoff <strong>Dental</strong> Associates 5849 Harbour View Blvd, Suite 100 Suffolk VA 23435 General <strong>Provider</strong> Suffolk City<br />

* Tam Amy 050724 Konikoff <strong>Dental</strong> Associates 5849 Harbour View Blvd, Suite 100 Suffolk VA 23435 General <strong>Provider</strong> Suffolk City<br />

* Throckmorton Maria 050724 Konikoff <strong>Dental</strong> Associates 5849 Harbour View Blvd, Suite 100 Suffolk VA 23435 General <strong>Provider</strong> Suffolk City<br />

Reynolds Jillian 078274 LWSS Dentistry for Children 210 Meadow View Blvd Suffolk VA 23435 Pedodontist Suffolk City<br />

Sachs Scott 078274 LWSS Dentistry for Children 210 Meadow View Blvd Suffolk VA 23435 Pedodontist Suffolk City<br />

Byrnside Valerie 051074 Scott R Goodove DDS PLC 5849 Harbour View Blvd, Suite 120 Suffolk VA 23435 Oral Surgeon Suffolk City<br />

Goodove Scott 051074 Scott R Goodove DDS PLC 5849 Harbour View Blvd, Suite 120 Suffolk VA 23435 Oral Surgeon Suffolk City<br />

Harris Christopher 051074 Scott R Goodove DDS PLC 5849 Harbour View Blvd, Suite 120 Suffolk VA 23435 Oral Surgeon Suffolk City<br />

Ellis Kevin 061307 Advanced Sedation Dentistry 616 Virginia Beach Blvd, Suite 102 Virginia Beach VA 23451 General <strong>Provider</strong> Virginia Beach City<br />

Futerman Len 061307 Advanced Sedation Dentistry 616 Virginia Beach Blvd, Suite 102 Virginia Beach VA 23451 General <strong>Provider</strong> Virginia Beach City<br />

Oduyelu Bukola 061308 Advanced Sedation Dentistry Specialists 616 Virginia Beach Blvd, Suite 102 Virginia Beach VA 23451 Pedodontist Virginia Beach City<br />

Ellis Kevin 001692 Kevin J. Ellis, D.M.D. Family Dentistry 205 34th Street, Suite 112 Virginia Beach VA 23451 General <strong>Provider</strong> Virginia Beach City<br />

* Abdelwahab Tamer 050723 Konikoff <strong>Dental</strong> Associates 2829 Shore Dr, Suite 100 Virginia Beach VA 23451 General <strong>Provider</strong> Virginia Beach City<br />

* Ansari Uzma 050723 Konikoff <strong>Dental</strong> Associates 2829 Shore Dr, Suite 100 Virginia Beach VA 23451 General <strong>Provider</strong> Virginia Beach City<br />

* Berrada Sanae 050723 Konikoff <strong>Dental</strong> Associates 2829 Shore Dr, Suite 100 Virginia Beach VA 23451 General <strong>Provider</strong> Virginia Beach City<br />

* Bozman Jenny 050723 Konikoff <strong>Dental</strong> Associates 2829 Shore Dr, Suite 100 Virginia Beach VA 23451 General <strong>Provider</strong> Virginia Beach City<br />

* Chawla Seema 050723 Konikoff <strong>Dental</strong> Associates 2829 Shore Dr, Suite 100 Virginia Beach VA 23451 General <strong>Provider</strong> Virginia Beach City<br />

* Dobson Roberta 050723 Konikoff <strong>Dental</strong> Associates 2829 Shore Dr, Suite 100 Virginia Beach VA 23451 General <strong>Provider</strong> Virginia Beach City<br />

* Dobson, III Joseph 050723 Konikoff <strong>Dental</strong> Associates 2829 Shore Dr, Suite 100 Virginia Beach VA 23451 General <strong>Provider</strong> Virginia Beach City<br />

* Elosta Wael 050723 Konikoff <strong>Dental</strong> Associates 2829 Shore Dr, Suite 100 Virginia Beach VA 23451 General <strong>Provider</strong> Virginia Beach City<br />

* Field Marcus 050723 Konikoff <strong>Dental</strong> Associates 2829 Shore Dr, Suite 100 Virginia Beach VA 23451 General <strong>Provider</strong> Virginia Beach City<br />

* Field Sheila 050723 Konikoff <strong>Dental</strong> Associates 2829 Shore Dr, Suite 100 Virginia Beach VA 23451 General <strong>Provider</strong> Virginia Beach City<br />

* Gioffre Mollie 050723 Konikoff <strong>Dental</strong> Associates 2829 Shore Dr, Suite 100 Virginia Beach VA 23451 General <strong>Provider</strong> Virginia Beach City<br />

* Hoek Meredith 050723 Konikoff <strong>Dental</strong> Associates 2829 Shore Dr, Suite 100 Virginia Beach VA 23451 General <strong>Provider</strong> Virginia Beach City<br />

* Jones Daniel 050723 Konikoff <strong>Dental</strong> Associates 2829 Shore Dr, Suite 100 Virginia Beach VA 23451 General <strong>Provider</strong> Virginia Beach City<br />

* Konikoff David 050723 Konikoff <strong>Dental</strong> Associates 2829 Shore Dr, Suite 100 Virginia Beach VA 23451 General <strong>Provider</strong> Virginia Beach City<br />

* Lanigan Jacqueline 050723 Konikoff <strong>Dental</strong> Associates 2829 Shore Dr, Suite 100 Virginia Beach VA 23451 General <strong>Provider</strong> Virginia Beach City<br />

* Maclin Ivetta 050723 Konikoff <strong>Dental</strong> Associates 2829 Shore Dr, Suite 100 Virginia Beach VA 23451 General <strong>Provider</strong> Virginia Beach City<br />

* Mady Zeyad 050723 Konikoff <strong>Dental</strong> Associates 2829 Shore Dr, Suite 100 Virginia Beach VA 23451 General <strong>Provider</strong> Virginia Beach City<br />

* Maniwang Jo-Marie 050723 Konikoff <strong>Dental</strong> Associates 2829 Shore Dr, Suite 100 Virginia Beach VA 23451 General <strong>Provider</strong> Virginia Beach City<br />

* Mattioli Michele 050723 Konikoff <strong>Dental</strong> Associates 2829 Shore Dr, Suite 100 Virginia Beach VA 23451 General <strong>Provider</strong> Virginia Beach City<br />

* McCarty Benjamin 050723 Konikoff <strong>Dental</strong> Associates 2829 Shore Dr, Suite 100 Virginia Beach VA 23451 General <strong>Provider</strong> Virginia Beach City<br />

* Miranda Joshua 050723 Konikoff <strong>Dental</strong> Associates 2829 Shore Dr, Suite 100 Virginia Beach VA 23451 General <strong>Provider</strong> Virginia Beach City<br />

* Morris Mason-Leigh 050723 Konikoff <strong>Dental</strong> Associates 2829 Shore Dr, Suite 100 Virginia Beach VA 23451 General <strong>Provider</strong> Virginia Beach City<br />

* Muldoon Catherine 050723 Konikoff <strong>Dental</strong> Associates 2829 Shore Dr, Suite 100 Virginia Beach VA 23451 General <strong>Provider</strong> Virginia Beach City<br />

* Parker Richard 050723 Konikoff <strong>Dental</strong> Associates 2829 Shore Dr, Suite 100 Virginia Beach VA 23451 General <strong>Provider</strong> Virginia Beach City<br />

* Pearl Dina 050723 Konikoff <strong>Dental</strong> Associates 2829 Shore Dr, Suite 100 Virginia Beach VA 23451 General <strong>Provider</strong> Virginia Beach City<br />

* Reichley John 050723 Konikoff <strong>Dental</strong> Associates 2829 Shore Dr, Suite 100 Virginia Beach VA 23451 General <strong>Provider</strong> Virginia Beach City<br />

* Richards Damdy 050723 Konikoff <strong>Dental</strong> Associates 2829 Shore Dr, Suite 100 Virginia Beach VA 23451 General <strong>Provider</strong> Virginia Beach City<br />

* Santos Estelito 050723 Konikoff <strong>Dental</strong> Associates 2829 Shore Dr, Suite 100 Virginia Beach VA 23451 General <strong>Provider</strong> Virginia Beach City<br />

* Solarte-Castro Edith 050723 Konikoff <strong>Dental</strong> Associates 2829 Shore Dr, Suite 100 Virginia Beach VA 23451 General <strong>Provider</strong> Virginia Beach City<br />

* Tam Amy 050723 Konikoff <strong>Dental</strong> Associates 2829 Shore Dr, Suite 100 Virginia Beach VA 23451 General <strong>Provider</strong> Virginia Beach City<br />

* Throckmorton Maria 050723 Konikoff <strong>Dental</strong> Associates 2829 Shore Dr, Suite 100 Virginia Beach VA 23451 General <strong>Provider</strong> Virginia Beach City<br />

Hartman Gary 002163 Gary A. Hartman, D.D.S., MS. Ltd 240 Mustang Tr Virginia Beach VA 23452 Periodontist Virginia Beach City<br />

Konikoff Albert 000255 Konikoff Periodontics, Ltd. 477 Viking Drive, #190 Virginia Beach VA 23452 Periodontist Virginia Beach City<br />

Folck Michael 033857 Mid Atlantic Implant and Oral Surgery Center, PC 272 Bendix Road, Suite 280 Virginia Beach VA 23452 Oral Surgeon Virginia Beach City<br />

Spain Murray 000097 Murray Spain, D.M.D. 3634 S. Plaza Trail #101 Virginia Beach VA 23452 General <strong>Provider</strong> Virginia Beach City<br />

Ashby John 000179 Owens and Dorfman, Ltd. 4356-4 Bonney Rd., #101 Virginia Beach VA 23452 Orthodontist Virginia Beach City<br />

Dailey Curtis 000179 Owens and Dorfman, Ltd. 4356-4 Bonney Rd., #101 Virginia Beach VA 23452 Orthodontist Virginia Beach City<br />

Nido Arthur 000076 Arthur Nido, D.M.D. 525 N. Great Neck Road Virginia Beach VA 23454 General <strong>Provider</strong> Virginia Beach City<br />

Ford Melvin 001096 Drs. Ford, Guter & Rai 933 First Colonial Road, Suite 205 Virginia Beach VA 23454 Oral Surgeon Virginia Beach City<br />

Guter Klaus 001096 Drs. Ford, Guter & Rai 933 First Colonial Road, Suite 205 Virginia Beach VA 23454 Oral Surgeon Virginia Beach City<br />

Rai Shaun 001096 Drs. Ford, Guter & Rai 933 First Colonial Road, Suite 205 Virginia Beach VA 23454 Oral Surgeon Virginia Beach City<br />

Elattrache Dean 002122 General Booth Endodontics, L.L.C. 2020 General Booth Blvd., Suite 100 Virginia Beach VA 23454 Endodontist Virginia Beach City<br />

Leidy Jeffrey 000080 Jeffrey R. Leidy, D.M.D., P.C. 1301 First Colonial Rd. Virginia Beach VA 23454 General <strong>Provider</strong> Virginia Beach City<br />

* Indicates dentist that is accepting current patients only.<br />

All <strong>Select</strong> <strong>Plan</strong> Dentists Page 52<br />

1 Same as a DHMO with fixed member copayments, no annual maximum dollar limits, no waiting periods, no deductibles, no pre-authorization paperwork or pre-treatment estimates and no<br />

claim forms or proof of loss (except in the case of out-of-area emergencies). Member must enroll with a General Dentist. Fac ID is used to indicate which facility a member chooses.


SELECT PLAN 1 DENTIST DIRECTORY<br />

Dentists listed are under contract as of 10/1/12<br />

Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />

Shulman Jeremy 001688 Jeremy Shulman, D.D.S., MS 1301 First Colonial Road Virginia Beach VA 23454 Periodontist Virginia Beach City<br />

Reynolds Jillian 078273 LWSS Dentistry for Children 1157 First Colonial Rd Virginia Beach VA 23454 Pedodontist Virginia Beach City<br />

Sachs Scott 078273 LWSS Dentistry for Children 1157 First Colonial Rd Virginia Beach VA 23454 Pedodontist Virginia Beach City<br />

Quigg Richard 001106 Richard K. Quigg, D.D.S. 984 First Colonial Rd., Ste. 300 Virginia Beach VA 23454 Oral Surgeon Virginia Beach City<br />

Byrnside Valerie 037684 Scott R. Goodove, D.D.S., PLC 1127 First Colonial Rd. Virginia Beach VA 23454 Oral Surgeon Virginia Beach City<br />

Goodove Scott 037684 Scott R. Goodove, D.D.S., PLC 1127 First Colonial Rd. Virginia Beach VA 23454 Oral Surgeon Virginia Beach City<br />

Harris Christopher 037684 Scott R. Goodove, D.D.S., PLC 1127 First Colonial Rd. Virginia Beach VA 23454 Oral Surgeon Virginia Beach City<br />

Berger Arnold 000027 The Doctors Berger DMD PLC 2404 Virginia Beach Blvd., Suite 106 Virginia Beach VA 23454 General <strong>Provider</strong> Virginia Beach City<br />

Berger Louis 000027 The Doctors Berger DMD PLC 2404 Virginia Beach Blvd., Suite 106 Virginia Beach VA 23454 General <strong>Provider</strong> Virginia Beach City<br />

Vendetti Curtis 033861 Virginia Surgical Arts, LLC 1240 Perimeter Parkway, Suite 401 Virginia Beach VA 23454 Oral Surgeon Virginia Beach City<br />

Spain Murray 002863 Murray Spain, Jr., D.M.D. 1127 Independence Blvd. Virginia Beach VA 23455 General <strong>Provider</strong> Virginia Beach City<br />

Mahanes Alan 000543 Alan Mahanes, D.D.S. 2521 North Landing Rd, 100 Virginia Beach VA 23456 General <strong>Provider</strong> Virginia Beach City<br />

Oduyelu Bukola 001552 Bukola A. Oduyelu, D.D.S., P.C. 2264 London Bridge Rd, Suite 105 Virginia Beach VA 23456 Pedodontist Virginia Beach City<br />

Ford Melvin 001366 Drs. Ford, Guter & Rai 2100 Lynnhaven Pkwy, Suite 102 Virginia Beach VA 23456 Oral Surgeon Virginia Beach City<br />

Guter Klaus 001366 Drs. Ford, Guter & Rai 2100 Lynnhaven Pkwy, Suite 102 Virginia Beach VA 23456 Oral Surgeon Virginia Beach City<br />

Rai Shaun 001366 Drs. Ford, Guter & Rai 2100 Lynnhaven Pkwy, Suite 102 Virginia Beach VA 23456 Oral Surgeon Virginia Beach City<br />

* Abdelwahab Tamer 050719 Konikoff <strong>Dental</strong> Associates 2100 Lynnhaven Pkwy, Suite 100 Virginia Beach VA 23456 General <strong>Provider</strong> Virginia Beach City<br />

* Abdelwahab Tamer 050720 Konikoff <strong>Dental</strong> Associates 2301 A General Booth Blvd Virginia Beach VA 23456 General <strong>Provider</strong> Virginia Beach City<br />

* Ansari Uzma 050719 Konikoff <strong>Dental</strong> Associates 2100 Lynnhaven Pkwy, Suite 100 Virginia Beach VA 23456 General <strong>Provider</strong> Virginia Beach City<br />

* Ansari Uzma 050720 Konikoff <strong>Dental</strong> Associates 2301 A General Booth Blvd Virginia Beach VA 23456 General <strong>Provider</strong> Virginia Beach City<br />

* Berrada Sanae 050719 Konikoff <strong>Dental</strong> Associates 2100 Lynnhaven Pkwy, Suite 100 Virginia Beach VA 23456 General <strong>Provider</strong> Virginia Beach City<br />

* Berrada Sanae 050720 Konikoff <strong>Dental</strong> Associates 2301 A General Booth Blvd Virginia Beach VA 23456 General <strong>Provider</strong> Virginia Beach City<br />

* Bozman Jenny 050719 Konikoff <strong>Dental</strong> Associates 2100 Lynnhaven Pkwy, Suite 100 Virginia Beach VA 23456 General <strong>Provider</strong> Virginia Beach City<br />

* Bozman Jenny 050720 Konikoff <strong>Dental</strong> Associates 2301 A General Booth Blvd Virginia Beach VA 23456 General <strong>Provider</strong> Virginia Beach City<br />

* Chawla Seema 050719 Konikoff <strong>Dental</strong> Associates 2100 Lynnhaven Pkwy, Suite 100 Virginia Beach VA 23456 General <strong>Provider</strong> Virginia Beach City<br />

* Chawla Seema 050720 Konikoff <strong>Dental</strong> Associates 2301 A General Booth Blvd Virginia Beach VA 23456 General <strong>Provider</strong> Virginia Beach City<br />

* Dobson Roberta 050719 Konikoff <strong>Dental</strong> Associates 2100 Lynnhaven Pkwy, Suite 100 Virginia Beach VA 23456 General <strong>Provider</strong> Virginia Beach City<br />

* Dobson Roberta 050720 Konikoff <strong>Dental</strong> Associates 2301 A General Booth Blvd Virginia Beach VA 23456 General <strong>Provider</strong> Virginia Beach City<br />

* Dobson, III Joseph 050719 Konikoff <strong>Dental</strong> Associates 2100 Lynnhaven Pkwy, Suite 100 Virginia Beach VA 23456 General <strong>Provider</strong> Virginia Beach City<br />

* Dobson, III Joseph 050720 Konikoff <strong>Dental</strong> Associates 2301 A General Booth Blvd Virginia Beach VA 23456 General <strong>Provider</strong> Virginia Beach City<br />

* Elosta Wael 050719 Konikoff <strong>Dental</strong> Associates 2100 Lynnhaven Pkwy, Suite 100 Virginia Beach VA 23456 General <strong>Provider</strong> Virginia Beach City<br />

* Elosta Wael 050720 Konikoff <strong>Dental</strong> Associates 2301 A General Booth Blvd Virginia Beach VA 23456 General <strong>Provider</strong> Virginia Beach City<br />

* Field Marcus 050719 Konikoff <strong>Dental</strong> Associates 2100 Lynnhaven Pkwy, Suite 100 Virginia Beach VA 23456 General <strong>Provider</strong> Virginia Beach City<br />

* Field Marcus 050720 Konikoff <strong>Dental</strong> Associates 2301 A General Booth Blvd Virginia Beach VA 23456 General <strong>Provider</strong> Virginia Beach City<br />

* Field Sheila 050719 Konikoff <strong>Dental</strong> Associates 2100 Lynnhaven Pkwy, Suite 100 Virginia Beach VA 23456 General <strong>Provider</strong> Virginia Beach City<br />

* Field Sheila 050720 Konikoff <strong>Dental</strong> Associates 2301 A General Booth Blvd Virginia Beach VA 23456 General <strong>Provider</strong> Virginia Beach City<br />

* Gioffre Mollie 050719 Konikoff <strong>Dental</strong> Associates 2100 Lynnhaven Pkwy, Suite 100 Virginia Beach VA 23456 General <strong>Provider</strong> Virginia Beach City<br />

* Gioffre Mollie 050720 Konikoff <strong>Dental</strong> Associates 2301 A General Booth Blvd Virginia Beach VA 23456 General <strong>Provider</strong> Virginia Beach City<br />

* Hoek Meredith 050719 Konikoff <strong>Dental</strong> Associates 2100 Lynnhaven Pkwy, Suite 100 Virginia Beach VA 23456 General <strong>Provider</strong> Virginia Beach City<br />

* Hoek Meredith 050720 Konikoff <strong>Dental</strong> Associates 2301 A General Booth Blvd Virginia Beach VA 23456 General <strong>Provider</strong> Virginia Beach City<br />

* Jones Daniel 050719 Konikoff <strong>Dental</strong> Associates 2100 Lynnhaven Pkwy, Suite 100 Virginia Beach VA 23456 General <strong>Provider</strong> Virginia Beach City<br />

* Jones Daniel 050720 Konikoff <strong>Dental</strong> Associates 2301 A General Booth Blvd Virginia Beach VA 23456 General <strong>Provider</strong> Virginia Beach City<br />

* Konikoff David 050719 Konikoff <strong>Dental</strong> Associates 2100 Lynnhaven Pkwy, Suite 100 Virginia Beach VA 23456 General <strong>Provider</strong> Virginia Beach City<br />

* Konikoff David 050720 Konikoff <strong>Dental</strong> Associates 2301 A General Booth Blvd Virginia Beach VA 23456 General <strong>Provider</strong> Virginia Beach City<br />

* Lanigan Jacqueline 050719 Konikoff <strong>Dental</strong> Associates 2100 Lynnhaven Pkwy, Suite 100 Virginia Beach VA 23456 General <strong>Provider</strong> Virginia Beach City<br />

* Lanigan Jacqueline 050720 Konikoff <strong>Dental</strong> Associates 2301 A General Booth Blvd Virginia Beach VA 23456 General <strong>Provider</strong> Virginia Beach City<br />

* Maclin Ivetta 050719 Konikoff <strong>Dental</strong> Associates 2100 Lynnhaven Pkwy, Suite 100 Virginia Beach VA 23456 General <strong>Provider</strong> Virginia Beach City<br />

* Maclin Ivetta 050720 Konikoff <strong>Dental</strong> Associates 2301 A General Booth Blvd Virginia Beach VA 23456 General <strong>Provider</strong> Virginia Beach City<br />

* Mady Zeyad 050719 Konikoff <strong>Dental</strong> Associates 2100 Lynnhaven Pkwy, Suite 100 Virginia Beach VA 23456 General <strong>Provider</strong> Virginia Beach City<br />

* Mady Zeyad 050720 Konikoff <strong>Dental</strong> Associates 2301 A General Booth Blvd Virginia Beach VA 23456 General <strong>Provider</strong> Virginia Beach City<br />

* Maniwang Jo-Marie 050719 Konikoff <strong>Dental</strong> Associates 2100 Lynnhaven Pkwy, Suite 100 Virginia Beach VA 23456 General <strong>Provider</strong> Virginia Beach City<br />

* Maniwang Jo-Marie 050720 Konikoff <strong>Dental</strong> Associates 2301 A General Booth Blvd Virginia Beach VA 23456 General <strong>Provider</strong> Virginia Beach City<br />

* Mattioli Michele 050719 Konikoff <strong>Dental</strong> Associates 2100 Lynnhaven Pkwy, Suite 100 Virginia Beach VA 23456 General <strong>Provider</strong> Virginia Beach City<br />

* Mattioli Michele 050720 Konikoff <strong>Dental</strong> Associates 2301 A General Booth Blvd Virginia Beach VA 23456 General <strong>Provider</strong> Virginia Beach City<br />

* McCarty Benjamin 050719 Konikoff <strong>Dental</strong> Associates 2100 Lynnhaven Pkwy, Suite 100 Virginia Beach VA 23456 General <strong>Provider</strong> Virginia Beach City<br />

* McCarty Benjamin 050720 Konikoff <strong>Dental</strong> Associates 2301 A General Booth Blvd Virginia Beach VA 23456 General <strong>Provider</strong> Virginia Beach City<br />

* Miranda Joshua 050719 Konikoff <strong>Dental</strong> Associates 2100 Lynnhaven Pkwy, Suite 100 Virginia Beach VA 23456 General <strong>Provider</strong> Virginia Beach City<br />

* Miranda Joshua 050720 Konikoff <strong>Dental</strong> Associates 2301 A General Booth Blvd Virginia Beach VA 23456 General <strong>Provider</strong> Virginia Beach City<br />

* Morris Mason-Leigh 050719 Konikoff <strong>Dental</strong> Associates 2100 Lynnhaven Pkwy, Suite 100 Virginia Beach VA 23456 General <strong>Provider</strong> Virginia Beach City<br />

* Morris Mason-Leigh 050720 Konikoff <strong>Dental</strong> Associates 2301 A General Booth Blvd Virginia Beach VA 23456 General <strong>Provider</strong> Virginia Beach City<br />

* Muldoon Catherine 050719 Konikoff <strong>Dental</strong> Associates 2100 Lynnhaven Pkwy, Suite 100 Virginia Beach VA 23456 General <strong>Provider</strong> Virginia Beach City<br />

* Muldoon Catherine 050720 Konikoff <strong>Dental</strong> Associates 2301 A General Booth Blvd Virginia Beach VA 23456 General <strong>Provider</strong> Virginia Beach City<br />

* Newman Michael 050719 Konikoff <strong>Dental</strong> Associates 2100 Lynnhaven Pkwy, Suite 100 Virginia Beach VA 23456 General <strong>Provider</strong> Virginia Beach City<br />

* Parker Richard 050719 Konikoff <strong>Dental</strong> Associates 2100 Lynnhaven Pkwy, Suite 100 Virginia Beach VA 23456 General <strong>Provider</strong> Virginia Beach City<br />

* Parker Richard 050720 Konikoff <strong>Dental</strong> Associates 2301 A General Booth Blvd Virginia Beach VA 23456 General <strong>Provider</strong> Virginia Beach City<br />

* Pearl Dina 050719 Konikoff <strong>Dental</strong> Associates 2100 Lynnhaven Pkwy, Suite 100 Virginia Beach VA 23456 General <strong>Provider</strong> Virginia Beach City<br />

* Indicates dentist that is accepting current patients only.<br />

All <strong>Select</strong> <strong>Plan</strong> Dentists Page 53<br />

1 Same as a DHMO with fixed member copayments, no annual maximum dollar limits, no waiting periods, no deductibles, no pre-authorization paperwork or pre-treatment estimates and no<br />

claim forms or proof of loss (except in the case of out-of-area emergencies). Member must enroll with a General Dentist. Fac ID is used to indicate which facility a member chooses.


SELECT PLAN 1 DENTIST DIRECTORY<br />

Dentists listed are under contract as of 10/1/12<br />

Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />

* Pearl Dina 050720 Konikoff <strong>Dental</strong> Associates 2301 A General Booth Blvd Virginia Beach VA 23456 General <strong>Provider</strong> Virginia Beach City<br />

* Reichley John 050719 Konikoff <strong>Dental</strong> Associates 2100 Lynnhaven Pkwy, Suite 100 Virginia Beach VA 23456 General <strong>Provider</strong> Virginia Beach City<br />

* Reichley John 050720 Konikoff <strong>Dental</strong> Associates 2301 A General Booth Blvd Virginia Beach VA 23456 General <strong>Provider</strong> Virginia Beach City<br />

* Richards Damdy 050719 Konikoff <strong>Dental</strong> Associates 2100 Lynnhaven Pkwy, Suite 100 Virginia Beach VA 23456 General <strong>Provider</strong> Virginia Beach City<br />

* Richards Damdy 050720 Konikoff <strong>Dental</strong> Associates 2301 A General Booth Blvd Virginia Beach VA 23456 General <strong>Provider</strong> Virginia Beach City<br />

* Santos Estelito 050719 Konikoff <strong>Dental</strong> Associates 2100 Lynnhaven Pkwy, Suite 100 Virginia Beach VA 23456 General <strong>Provider</strong> Virginia Beach City<br />

* Santos Estelito 050720 Konikoff <strong>Dental</strong> Associates 2301 A General Booth Blvd Virginia Beach VA 23456 General <strong>Provider</strong> Virginia Beach City<br />

* Solarte-Castro Edith 050719 Konikoff <strong>Dental</strong> Associates 2100 Lynnhaven Pkwy, Suite 100 Virginia Beach VA 23456 General <strong>Provider</strong> Virginia Beach City<br />

* Solarte-Castro Edith 050720 Konikoff <strong>Dental</strong> Associates 2301 A General Booth Blvd Virginia Beach VA 23456 General <strong>Provider</strong> Virginia Beach City<br />

* Tam Amy 050719 Konikoff <strong>Dental</strong> Associates 2100 Lynnhaven Pkwy, Suite 100 Virginia Beach VA 23456 General <strong>Provider</strong> Virginia Beach City<br />

* Tam Amy 050720 Konikoff <strong>Dental</strong> Associates 2301 A General Booth Blvd Virginia Beach VA 23456 General <strong>Provider</strong> Virginia Beach City<br />

* Throckmorton Maria 050719 Konikoff <strong>Dental</strong> Associates 2100 Lynnhaven Pkwy, Suite 100 Virginia Beach VA 23456 General <strong>Provider</strong> Virginia Beach City<br />

* Throckmorton Maria 050720 Konikoff <strong>Dental</strong> Associates 2301 A General Booth Blvd Virginia Beach VA 23456 General <strong>Provider</strong> Virginia Beach City<br />

Bergano Allan 000243 Allan L. Bergano, DDS, PC 256 N. Witchduck Rd., Unit D Virginia Beach VA 23462 General <strong>Provider</strong> Virginia Beach City<br />

* Karp Allen 001231 Allen Karp Family Dentistry 4676 Princess Anne Rd, suite 100 Virginia Beach VA 23462 General <strong>Provider</strong> Virginia Beach City<br />

Ford Melvin 001097 Drs. Ford, Guter & Rai 5720 Greenwich Rd. Virginia Beach VA 23462 Oral Surgeon Virginia Beach City<br />

Guter Klaus 001097 Drs. Ford, Guter & Rai 5720 Greenwich Rd. Virginia Beach VA 23462 Oral Surgeon Virginia Beach City<br />

Rai Shaun 001097 Drs. Ford, Guter & Rai 5720 Greenwich Rd. Virginia Beach VA 23462 Oral Surgeon Virginia Beach City<br />

Ochave Frederick 001745 Frederick P. Ochave, D.M.D 289 Independence Blvd., Pembroke 3, Suite #229 Virginia Beach VA 23462 General <strong>Provider</strong> Virginia Beach City<br />

Kern Donald 001533 Harmony <strong>Dental</strong> Group / Donald F Kern DDS 401 Green Meadows Dr, Suite B Virginia Beach VA 23462 General <strong>Provider</strong> Virginia Beach City<br />

Scott Jon 000247 Jon L. Scott, D.D.S., M.S. 114 South Witchduck Rd. Virginia Beach VA 23462 Orthodontist Virginia Beach City<br />

* Gladstone Myron 000201 Drs. Gladstone & Salerno 5318 Providence Rd. Virginia Beach VA 23464 General <strong>Provider</strong> Virginia Beach City<br />

* Salerno James 000201 Drs. Gladstone & Salerno 5318 Providence Rd. Virginia Beach VA 23464 General <strong>Provider</strong> Virginia Beach City<br />

* Smith Jacqueline 050338 Jacqueline B Smith DDS PLLC 1385 Fordham Dr, Suite 106 Virginia Beach VA 23464 General <strong>Provider</strong> Virginia Beach City<br />

Reynolds Jillian 078271 LWSS Dentistry for Children 904 Kempsville Rd Virginia Beach VA 23464 Pedodontist Virginia Beach City<br />

Sachs Scott 078271 LWSS Dentistry for Children 904 Kempsville Rd Virginia Beach VA 23464 Pedodontist Virginia Beach City<br />

Morrison Sanford 000721 S. Neil Morrison, DDS & Melvin R. Morrison, DDS 904 Kempsville Rd., Ste 102 Virginia Beach VA 23464 Oral Surgeon Virginia Beach City<br />

Conelias Trent 002842 Trent P. Conelias, DDS 6033 Providence Rd. Virginia Beach VA 23464 Oral Surgeon Virginia Beach City<br />

* Indicates dentist that is accepting current patients only.<br />

All <strong>Select</strong> <strong>Plan</strong> Dentists Page 54<br />

1 Same as a DHMO with fixed member copayments, no annual maximum dollar limits, no waiting periods, no deductibles, no pre-authorization paperwork or pre-treatment estimates and no<br />

claim forms or proof of loss (except in the case of out-of-area emergencies). Member must enroll with a General Dentist. Fac ID is used to indicate which facility a member chooses.

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