Select Plan Provider Directory - Dominion Dental Services, Inc.

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SELECT PLAN 1 DENTIST DIRECTORY Dentists listed are under contract as of 10/1/12 Last Name First Name Fac ID Dental Office Name Office Address City ST ZIP Discipline County Levy Jamie 002809 American Dental Care, PA 61 S. Blackhorse Pike Blackwood NJ 08012 Oral Surgeon Camden Li Fuming 002809 American Dental Care, PA 61 S. Blackhorse Pike Blackwood NJ 08012 General Provider Camden Morgenstern Thomas 002809 American Dental Care, PA 61 S. Blackhorse Pike Blackwood NJ 08012 Orthodontist Camden Ruggieri John 002809 American Dental Care, PA 61 S. Blackhorse Pike Blackwood NJ 08012 General Provider Camden Gelman Robert 000661 Gelman Dental Associates 639 Market Street Camden NJ 08102 General Provider Camden Kaye Gary 000661 Gelman Dental Associates 639 Market Street Camden NJ 08102 General Provider Camden Bandola Krystin 000710 Matthew Eichen, D.M.D., P.A. 17 W. Ormond Ave Cherry Hill NJ 08034 Oral Surgeon Camden Chi Kai-Zu 000710 Matthew Eichen, D.M.D., P.A. 17 W. Ormond Ave Cherry Hill NJ 08034 Oral Surgeon Camden Eichen Matthew 000710 Matthew Eichen, D.M.D., P.A. 17 W. Ormond Ave Cherry Hill NJ 08034 Oral Surgeon Camden * Friedland Gary 000717 Fries Mill Dental Associates, P.A. 188 Fries Mill Road, L-3 Turnersville NJ 08012 General Provider Camden Casey Joseph 002864 American Dental Care, PA 2 Sheppard Rd., Suite 100 Voorhees NJ 08043 General Provider Camden Choksi Raj 002864 American Dental Care, PA 2 Sheppard Rd., Suite 100 Voorhees NJ 08043 General Provider Camden Costello William 002864 American Dental Care, PA 2 Sheppard Rd., Suite 100 Voorhees NJ 08043 General Provider Camden Gershkovich Candace 002864 American Dental Care, PA 2 Sheppard Rd., Suite 100 Voorhees NJ 08043 General Provider Camden Khan Aliya 002864 American Dental Care, PA 2 Sheppard Rd., Suite 100 Voorhees NJ 08043 General Provider Camden Koff Howard 002864 American Dental Care, PA 2 Sheppard Rd., Suite 100 Voorhees NJ 08043 Orthodontist Camden Li Fuming 002864 American Dental Care, PA 2 Sheppard Rd., Suite 100 Voorhees NJ 08043 General Provider Camden Morgenstern Thomas 002864 American Dental Care, PA 2 Sheppard Rd., Suite 100 Voorhees NJ 08043 Orthodontist Camden Ruggieri John 002864 American Dental Care, PA 2 Sheppard Rd., Suite 100 Voorhees NJ 08043 General Provider Camden Mashru Poonam 050733 Family Dental Care of South Jersey 707 Haddonfield Berlin Road Voorhees NJ 08043 General Provider Camden Schupper Jeffrey 050733 Family Dental Care of South Jersey 707 Haddonfield Berlin Road Voorhees NJ 08043 General Provider Camden Tenbrook James 080789 Tenbrook Orthodontics 508 Shiloh Pike Bridgeton NJ 08302 Orthodontist Cumberland Tenbrook James 080792 Tenbrook Orthodontics 1030 N High Street Millville NJ 08332 Orthodontist Cumberland Tenbrook James 080787 Tenbrook Orthodontics 1101 Wheaton Ave Millville NJ 08332 Orthodontist Cumberland Bandola Krystin 069551 Matthew Eichen, D.M.D., P.A. 83 S State St Vineland NJ 08360 Oral Surgeon Cumberland Chi Kai-Zu 069551 Matthew Eichen, D.M.D., P.A. 83 S State St Vineland NJ 08360 Oral Surgeon Cumberland Eichen Matthew 069551 Matthew Eichen, D.M.D., P.A. 83 S State St Vineland NJ 08360 Oral Surgeon Cumberland Tenbrook James 080786 Tenbrook Orthodontics 630 Brewster Rd, Unit D-1 Vineland NJ 08361 Orthodontist Cumberland Pericci Jeffrey 000724 Jeffrey M. Perricci, D.M.D. 123 Van Buren Street Newark NJ 07105 General Provider Essex Azizogli Amer 000834 Amer Azizogli, D.D.S. 175 Franklin Ave., Suite 101 Nutley NJ 07110 General Provider Essex Casey Joseph 002806 American Dental Care, PA 1450 Clements Bridge Rd. Deptford NJ 08096 General Provider Gloucester Choksi Raj 002806 American Dental Care, PA 1450 Clements Bridge Rd. Deptford NJ 08096 General Provider Gloucester Costello William 002806 American Dental Care, PA 1450 Clements Bridge Rd. Deptford NJ 08096 General Provider Gloucester Gacita Anthony 002806 American Dental Care, PA 1450 Clements Bridge Rd. Deptford NJ 08096 General Provider Gloucester Gershkovich Candace 002806 American Dental Care, PA 1450 Clements Bridge Rd. Deptford NJ 08096 General Provider Gloucester Khan Aliya 002806 American Dental Care, PA 1450 Clements Bridge Rd. Deptford NJ 08096 General Provider Gloucester Koff Howard 002806 American Dental Care, PA 1450 Clements Bridge Rd. Deptford NJ 08096 Orthodontist Gloucester Li Fuming 002806 American Dental Care, PA 1450 Clements Bridge Rd. Deptford NJ 08096 General Provider Gloucester Morgenstern Thomas 002806 American Dental Care, PA 1450 Clements Bridge Rd. Deptford NJ 08096 Orthodontist Gloucester Ruggieri John 002806 American Dental Care, PA 1450 Clements Bridge Rd. Deptford NJ 08096 General Provider Gloucester Shamseddin Seyed 002806 American Dental Care, PA 1450 Clements Bridge Rd. Deptford NJ 08096 Periodontist Gloucester Tenbrook James 080790 Tenbrook Orthodontics 108 Route 322, Unit 3 Mullica Hill NJ 08062 Orthodontist Gloucester Tenbrook James 080793 Tenbrook Orthodontics 304 Hurffville Crosskeys Rd Sewell NJ 08080 Orthodontist Gloucester Eslami Ali 001305 Turnersville Family Dentistry 123 Eggharbor Rd. Sewell NJ 08080 General Provider Gloucester Tenbrook James 080788 Tenbrook Orthodontics 1630 Route 322, Suite B Woolwich Township NJ 08085 Orthodontist Gloucester Gerhard Ronald 000811 Ronald F Gerhard DDS PA 834 Avenue C Bayonne NJ 07002 Periodontist Hudson Vahid Arash 072101 AV Dental Associates PA 642 Newark Ave Jersey City NJ 07306 General Provider Hudson Pericci Jeffrey 000714 Jeffrey M. Perricci, D.M.D. 594 Kearny Avenue, P.O. Box 523 Kearny NJ 07032 General Provider Hudson Eisenberg Adam 000685 Adam G. Eisenberg, D.D.S. 710 Alexander Rd. Princeton NJ 08540 General Provider Mercer Patel Priya 033850 Personalized Dental Care, P.C. 805 Inman Ave Colonia NJ 07067 General Provider Middlesex Zhu Lin 033864 New Century Dental, Inc. 2163 Oak Tree Rd., Suite 106 Edison NJ 08820 General Provider Middlesex Patel Paresh 002730 Healthy Smiles Dental Assoc, LLC 295 Main Street Metuchen NJ 08840 General Provider Middlesex Eisenberg Adam 000485 Adam G. Eisenberg, D.D.S. Central Mediplex, 495 Iron Bridge Rd. #9 Freehold NJ 07728 General Provider Monmouth Eisenberg Adam 037713 Drs. Eisenberg of Ocean 2002 Sunset Ave Ocean NJ 07712 General Provider Monmouth Gerhard Ronald 002137 Ronald F Gerhard DDS PA 225 Highway 35 Red Bank NJ 07701 Periodontist Monmouth Festina Alla 002564 Alla Festina, DDS, PC 301 Prospect Avenue Pine Beach NJ 08741 General Provider Ocean Yassein Ibraheim 002598 Dental Care Center 426 Union Ave. Paterson NJ 07502 General Provider Passaic Tenbrook James 080791 Tenbrook Orthodontics 8596 Route 40 / Route 45 Woodstown NJ 08098 Orthodontist Salem Anithottam Abraham 002816 Abraham Joseph Anithottam 390 Amwell Road, Suite 102 Hillsborough NJ 08844 Orthodontist Somerset Karandikar Rajashree 079090 Manville Dental Group LLC 7 Washington Ave Manville NJ 08835 General Provider Somerset Small Gary 079090 Manville Dental Group LLC 7 Washington Ave Manville NJ 08835 General Provider Somerset Trivedi Nirali 079090 Manville Dental Group LLC 7 Washington Ave Manville NJ 08835 General Provider Somerset Wadhwa Nandhi 079090 Manville Dental Group LLC 7 Washington Ave Manville NJ 08835 General Provider Somerset Emmert Richard 001487 Emmert Dental Associates, P.C. 2404 Oxford Drive Bethel Park PA 15102 General Provider Allegheny Manalo Arsenio 001209 Manalo Family Dentistry, P.C. 2414 Lytle Rd.,Ste. 106 Bethel Park PA 15102 General Provider Allegheny Adams William 000985 Katsur Dental & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 General Provider Allegheny * Indicates dentist that is accepting current patients only. All Select Plan Dentists Page 10 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 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 Dentists listed are under contract as of 10/1/12 Last Name First Name Fac ID Dental Office Name Office Address City ST ZIP Discipline County Affolter John 000985 Katsur Dental & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 General Provider Allegheny Alagirisamy Kiruthika 000985 Katsur Dental & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 General Provider Allegheny Carozza Roselyn 000985 Katsur Dental & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 General Provider Allegheny Cohen Ira 000985 Katsur Dental & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 General Provider Allegheny Dahar Nicholas 000985 Katsur Dental & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 Orthodontist Allegheny Damich Louis 000985 Katsur Dental & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 General Provider Allegheny Ghaffari Catherine 000985 Katsur Dental & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 General Provider Allegheny Ghajarnia M. Reza 000985 Katsur Dental & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 Orthodontist Allegheny Gillen Steve 000985 Katsur Dental & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 General Provider Allegheny Iszkula Steven 000985 Katsur Dental & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 Orthodontist Allegheny Katsur James 000985 Katsur Dental & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 General Provider Allegheny Khurana Leena 000985 Katsur Dental & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 General Provider Allegheny Kier Calvin 000985 Katsur Dental & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 General Provider Allegheny King David 000985 Katsur Dental & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 Orthodontist Allegheny Kolla Siva 000985 Katsur Dental & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 General Provider Allegheny Lewis Howell 000985 Katsur Dental & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 Orthodontist Allegheny Miller Van 000985 Katsur Dental & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 Orthodontist Allegheny Pryor Leroy 000985 Katsur Dental & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 General Provider Allegheny Rinchuse Dara 000985 Katsur Dental & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 Orthodontist Allegheny Schmidt Alan 000985 Katsur Dental & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 General Provider Allegheny Smiga Ingrid 000985 Katsur Dental & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 General Provider Allegheny Stein Mark 000985 Katsur Dental & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 General Provider Allegheny Tinnemeyer Anjuli 000985 Katsur Dental & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 General Provider Allegheny Zalakar Frank 000985 Katsur Dental & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 General Provider Allegheny Dandashi Moutaz 050688 Katsur Dental & Orthodontics Specialists 1597 Washington Pike, Suite A5 Bridgeville PA 15017 Pedodontist Allegheny Hertzler L Gregory 050688 Katsur Dental & Orthodontics Specialists 1597 Washington Pike, Suite A5 Bridgeville PA 15017 Oral Surgeon Allegheny Kelly Derek 050688 Katsur Dental & Orthodontics Specialists 1597 Washington Pike, Suite A5 Bridgeville PA 15017 Oral Surgeon Allegheny Kier Gregory 050688 Katsur Dental & Orthodontics Specialists 1597 Washington Pike, Suite A5 Bridgeville PA 15017 Periodontist Allegheny Monti Richard 050688 Katsur Dental & Orthodontics Specialists 1597 Washington Pike, Suite A5 Bridgeville PA 15017 Oral Surgeon Allegheny Iurlano David 001246 David Iurlano, D.M.D. 1101 Fifth Ave. Coraopolis PA 15108 General Provider Allegheny Mancini James 001280 James Mancini, D.M.D., P.C. 327 Forest Grove Rd. Coraopolis PA 15108 General Provider Allegheny Wintner Morton 001749 Morton Wintner, D.M.D. 850 Beaver Grade Rd. Coraopolis PA 15108 Orthodontist Allegheny Wielechowski David 051077 DMW Family Dentistry 5318 Ranalli Dr, Suite 410 Gibsonia PA 15044 General Provider Allegheny Affolter John 002117 Katsur Dental & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 General Provider Allegheny Alagirisamy Kiruthika 002117 Katsur Dental & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 General Provider Allegheny Carozza Roselyn 002117 Katsur Dental & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 General Provider Allegheny Cohen Ira 002117 Katsur Dental & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 General Provider Allegheny Dahar Nicholas 002117 Katsur Dental & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 Orthodontist Allegheny Damich Louis 002117 Katsur Dental & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 General Provider Allegheny Dandashi Moutaz 002117 Katsur Dental & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 Pedodontist Allegheny Ghaffari Catherine 002117 Katsur Dental & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 General Provider Allegheny Ghajarnia M. Reza 002117 Katsur Dental & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 Orthodontist Allegheny Gillen Steve 002117 Katsur Dental & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 General Provider Allegheny Hertzler L Gregory 002117 Katsur Dental & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 Oral Surgeon Allegheny Iszkula Steven 002117 Katsur Dental & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 Orthodontist Allegheny Katsur James 002117 Katsur Dental & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 General Provider Allegheny Kelly Derek 002117 Katsur Dental & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 Oral Surgeon Allegheny Khurana Leena 002117 Katsur Dental & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 General Provider Allegheny Kier Calvin 002117 Katsur Dental & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 General Provider Allegheny Kier Gregory 002117 Katsur Dental & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 Periodontist Allegheny King David 002117 Katsur Dental & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 Orthodontist Allegheny Kolla Siva 002117 Katsur Dental & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 General Provider Allegheny Lewis Howell 002117 Katsur Dental & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 Orthodontist Allegheny Miller Van 002117 Katsur Dental & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 Orthodontist Allegheny Pryor Leroy 002117 Katsur Dental & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 General Provider Allegheny Rinchuse Dara 002117 Katsur Dental & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 Orthodontist Allegheny Schmidt Alan 002117 Katsur Dental & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 General Provider Allegheny Smiga Ingrid 002117 Katsur Dental & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 General Provider Allegheny Stein Mark 002117 Katsur Dental & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 General Provider Allegheny Zalakar Frank 002117 Katsur Dental & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 General Provider Allegheny Bonczek Brian 051012 Aspen Dental 240 Waterfront Dr E Homestead PA 15120 General Provider Allegheny Ciarallo Robert 051012 Aspen Dental 240 Waterfront Dr E Homestead PA 15120 Oral Surgeon Allegheny Grinberg Anna 051012 Aspen Dental 240 Waterfront Dr E Homestead PA 15120 General Provider Allegheny Monaco Natalie 051012 Aspen Dental 240 Waterfront Dr E Homestead PA 15120 General Provider Allegheny Ruprecht Heather 051012 Aspen Dental 240 Waterfront Dr E Homestead PA 15120 General Provider Allegheny Shieh Andy 051012 Aspen Dental 240 Waterfront Dr E Homestead PA 15120 General Provider Allegheny * Indicates dentist that is accepting current patients only. All Select Plan Dentists Page 11 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 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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Select Plan Provider Directory - Dominion Dental Services, Inc.

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