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 Barnes Willie 068522 Family Dentistry 4896 Nittany Valley Dr, Box 397 Lamar PA 16848 General Provider Clinton * Patchin Harry 001712 Harry V Patchin DMD 407 S 32nd St Camp Hill PA 17011 General Provider Cumberland Gensbigler Joseph 002527 West Shore Family Dentistry, LTD 40 North 36th Street Camp Hill PA 17011 General Provider Cumberland Gensbigler Thomas 002527 West Shore Family Dentistry, LTD 40 North 36th Street Camp Hill PA 17011 General Provider Cumberland Yelk Peter 002527 West Shore Family Dentistry, LTD 40 North 36th Street Camp Hill PA 17011 General Provider Cumberland Babameto Blendi 050403 Aspen Dental 6416 Carlisle Pike, Suite 500 Mechanicsburg PA 17050 Oral Surgeon Cumberland Ciarallo Robert 050403 Aspen Dental 6416 Carlisle Pike, Suite 500 Mechanicsburg PA 17050 Oral Surgeon Cumberland Desai Jagruti 050403 Aspen Dental 6416 Carlisle Pike, Suite 500 Mechanicsburg PA 17050 General Provider Cumberland Kaur Kamaljit 050403 Aspen Dental 6416 Carlisle Pike, Suite 500 Mechanicsburg PA 17050 General Provider Cumberland Kuleva Juliana 050403 Aspen Dental 6416 Carlisle Pike, Suite 500 Mechanicsburg PA 17050 General Provider Cumberland Popernack John 050403 Aspen Dental 6416 Carlisle Pike, Suite 500 Mechanicsburg PA 17050 General Provider Cumberland Talati Ankit 050403 Aspen Dental 6416 Carlisle Pike, Suite 500 Mechanicsburg PA 17050 General Provider Cumberland Withanachchi Janatha 050403 Aspen Dental 6416 Carlisle Pike, Suite 500 Mechanicsburg PA 17050 Endodontist Cumberland Lahar Craig 001438 Craig E. Lahar, DMD OMS, P.C. 200 Cumberland Parkway Mechanicsburg PA 17055 Oral Surgeon Cumberland * Reese Terry 001476 Drs. Warren and Reese 324 E. Main Street Mechanicsburg PA 17055 General Provider Cumberland * Warren William 001476 Drs. Warren and Reese 324 E. Main Street Mechanicsburg PA 17055 General Provider Cumberland Patel Prafulchandra 050512 American Dental Care LLC 4811 Jonestown Rd, Suite 129 Harrisburg PA 17109 General Provider Dauphin Parikh Yogeshi 002773 Uptown Family Dentistry 2626 N 3rd Street, Suite3C Harrisburg PA 17110 General Provider Dauphin Ramos Jesus 002773 Uptown Family Dentistry 2626 N 3rd Street, Suite3C Harrisburg PA 17110 General Provider Dauphin Babameto Blendi 002749 Aspen Dental Associates of NY, PC 4265 Union Deposit Rd. Harrisburg PA 17111 Oral Surgeon Dauphin Butler Deborah 002749 Aspen Dental Associates of NY, PC 4265 Union Deposit Rd. Harrisburg PA 17111 General Provider Dauphin Ciarallo Robert 002749 Aspen Dental Associates of NY, PC 4265 Union Deposit Rd. Harrisburg PA 17111 Oral Surgeon Dauphin Desai Jagruti 002749 Aspen Dental Associates of NY, PC 4265 Union Deposit Rd. Harrisburg PA 17111 General Provider Dauphin Kaur Kamaljit 002749 Aspen Dental Associates of NY, PC 4265 Union Deposit Rd. Harrisburg PA 17111 General Provider Dauphin Kuleva Juliana 002749 Aspen Dental Associates of NY, PC 4265 Union Deposit Rd. Harrisburg PA 17111 General Provider Dauphin Popernack John 002749 Aspen Dental Associates of NY, PC 4265 Union Deposit Rd. Harrisburg PA 17111 General Provider Dauphin Talati Ankit 002749 Aspen Dental Associates of NY, PC 4265 Union Deposit Rd. Harrisburg PA 17111 General Provider Dauphin Withanachchi Janatha 002749 Aspen Dental Associates of NY, PC 4265 Union Deposit Rd. Harrisburg PA 17111 Endodontist Dauphin Watson John 001346 John J. Watson, D.D.S. 4707 Derry St. Harrisburg PA 17111 General Provider Dauphin Wojdylak Michael 000982 Michael Wojdylak, D.D.S. 61 Roosevelt Blvd, Suite 4 Harrisburg PA 17111 General Provider Dauphin Yoffe John 002230 John A. Yoffe, D.M.D. 2213 Forest Hills Drive Harrisburg PA 17112 Orthodontist Dauphin Dinello Donald 002193 Mid-Penn Oral Surgery 2201 Dover Rd Harrisburg PA 17112 Oral Surgeon Dauphin Rajchel Jeffrey 002193 Mid-Penn Oral Surgery 2201 Dover Rd Harrisburg PA 17112 Oral Surgeon Dauphin Patel Prafulchandra 001905 American Dental Care, L.L.C. 1135 E Chocolate Ave, Suite 101 Hershey PA 17033 General Provider Dauphin Patel Bhargav 069972 Hershey Dental Care 555 E Chocolate Ave Hershey PA 17033 General Provider Dauphin Jackson Carl 001528 Aston Family Dental Care 3200 Concord Rd., Ste.200 Aston PA 19014 General Provider Delaware Smith Alan 000840 Alan Jeffrey Smith, D.M.D. 130 E. Brookhaven Rd. Brookhaven PA 19015 General Provider Delaware Tewari Dinesh 069538 Brookhaven Family Dentistry 4 W Brookhaven Rd Brookhaven PA 19015 General Provider Delaware Panossian Antoine 070975 A+ Oral Surgery Specialty Care PC 8 Ponds Edge Dr, Suite 2 Chadds Ford PA 19317 Oral Surgeon Delaware Tran David 070975 A+ Oral Surgery Specialty Care PC 8 Ponds Edge Dr, Suite 2 Chadds Ford PA 19317 Oral Surgeon Delaware Bandelac Georges 070949 A+ Periodontic Specialty Care PC 8 Ponds Edge Dr, Suite 2 Chadds Ford PA 19317 Periodontist Delaware Evans Marianna 070949 A+ Periodontic Specialty Care PC 8 Ponds Edge Dr, Suite 2 Chadds Ford PA 19317 Periodontist Delaware Agrawal Avanti 002356 Advanced Family Dentistry PC 8 Pond's Edge Drive, Suite 2 Chadds Ford PA 19317 General Provider Delaware Ahmadzadeh Bijan 002356 Advanced Family Dentistry PC 8 Pond's Edge Drive, Suite 2 Chadds Ford PA 19317 General Provider Delaware Cho Woohyun 002356 Advanced Family Dentistry PC 8 Pond's Edge Drive, Suite 2 Chadds Ford PA 19317 General Provider Delaware Dapkute Ingrida 002356 Advanced Family Dentistry PC 8 Pond's Edge Drive, Suite 2 Chadds Ford PA 19317 General Provider Delaware Derosa Daniel 002356 Advanced Family Dentistry PC 8 Pond's Edge Drive, Suite 2 Chadds Ford PA 19317 General Provider Delaware Desai Kaushal 002356 Advanced Family Dentistry PC 8 Pond's Edge Drive, Suite 2 Chadds Ford PA 19317 General Provider Delaware Gombar Anna 002356 Advanced Family Dentistry PC 8 Pond's Edge Drive, Suite 2 Chadds Ford PA 19317 General Provider Delaware Kopp Anatoliy 002356 Advanced Family Dentistry PC 8 Pond's Edge Drive, Suite 2 Chadds Ford PA 19317 General Provider Delaware Lee Young 002356 Advanced Family Dentistry PC 8 Pond's Edge Drive, Suite 2 Chadds Ford PA 19317 General Provider Delaware Merin Jared 002356 Advanced Family Dentistry PC 8 Pond's Edge Drive, Suite 2 Chadds Ford PA 19317 General Provider Delaware Mitelman Alexandra 002356 Advanced Family Dentistry PC 8 Pond's Edge Drive, Suite 2 Chadds Ford PA 19317 General Provider Delaware Moriarty Sean 002356 Advanced Family Dentistry PC 8 Pond's Edge Drive, Suite 2 Chadds Ford PA 19317 General Provider Delaware Savani Bhaskar 002356 Advanced Family Dentistry PC 8 Pond's Edge Drive, Suite 2 Chadds Ford PA 19317 General Provider Delaware Savani Bhumi 002356 Advanced Family Dentistry PC 8 Pond's Edge Drive, Suite 2 Chadds Ford PA 19317 General Provider Delaware Savani Niranjan 002356 Advanced Family Dentistry PC 8 Pond's Edge Drive, Suite 2 Chadds Ford PA 19317 General Provider Delaware Singh Jagdeep 002356 Advanced Family Dentistry PC 8 Pond's Edge Drive, Suite 2 Chadds Ford PA 19317 General Provider Delaware Todd Meredith 002356 Advanced Family Dentistry PC 8 Pond's Edge Drive, Suite 2 Chadds Ford PA 19317 General Provider Delaware Yoon Jaewon 002356 Advanced Family Dentistry PC 8 Pond's Edge Drive, Suite 2 Chadds Ford PA 19317 General Provider Delaware Turk Albert 001446 Albert Turk, D.M.D 127 Wilmington West, Chester Pike Chadds Ford PA 19317 General Provider Delaware Charkas Ahmad 070956 Allied Orthodontics PC 8 Ponds Edge Dr, Suite 2 Chadds Ford PA 19317 Orthodontist Delaware Evans Marianna 070956 Allied Orthodontics PC 8 Ponds Edge Dr, Suite 2 Chadds Ford PA 19317 Orthodontist Delaware Barboza Maria Helena 033848 Centre for Cosmetic Dentistry 275 Wilmington Westchester Pk, Ste. 111 Chadds Ford PA 19317 General Provider Delaware Hayes Richard 000662 Orthodontic Associates 3920 Pyle Road Chadds Ford PA 19317 Orthodontist Delaware DePanicis Vincent 002003 ChesPenn Health Services 125 E 9th Street Chester PA 19013 General Provider Delaware * Indicates dentist that is accepting current patients only. All Select Plan Dentists Page 22 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 DePanicis Vincent 002004 ChesPenn Health Services 2602 West 9th Street Chester PA 19013 General Provider Delaware Kane Michael 002003 ChesPenn Health Services 125 E 9th Street Chester PA 19013 General Provider Delaware Kane Michael 002004 ChesPenn Health Services 2602 West 9th Street Chester PA 19013 General Provider Delaware Koshetar Nancy 002003 ChesPenn Health Services 125 E 9th Street Chester PA 19013 General Provider Delaware Koshetar Nancy 002004 ChesPenn Health Services 2602 West 9th Street Chester PA 19013 General Provider Delaware Tran Alyssa Dieu Tra 002003 ChesPenn Health Services 125 E 9th Street Chester PA 19013 General Provider Delaware Tran Alyssa Dieu Tra 002004 ChesPenn Health Services 2602 West 9th Street Chester PA 19013 General Provider Delaware Belkin Philip 001453 The Saltz Dental Center 616 Avenue of the States Chester PA 19013 General Provider Delaware Cooper Howard 001453 The Saltz Dental Center 616 Avenue of the States Chester PA 19013 General Provider Delaware Dhruva Ashvinskumar 001453 The Saltz Dental Center 616 Avenue of the States Chester PA 19013 General Provider Delaware Marinchak Michael 001453 The Saltz Dental Center 616 Avenue of the States Chester PA 19013 General Provider Delaware Sanfacon Dennis 001453 The Saltz Dental Center 616 Avenue of the States Chester PA 19013 General Provider Delaware Spevak Joseph 001453 The Saltz Dental Center 616 Avenue of the States Chester PA 19013 General Provider Delaware Bahram Ramin 078258 Oral Surgery Consultants of PA 151 South Springfield Road Clifton Heights PA 19018 Oral Surgeon Delaware Bowser Daniel 078258 Oral Surgery Consultants of PA 151 South Springfield Road Clifton Heights PA 19018 Oral Surgeon Delaware Richman Brad 078258 Oral Surgery Consultants of PA 151 South Springfield Road Clifton Heights PA 19018 Oral Surgeon Delaware Kabil Abdallah 002127 Hollyland Dental Center 917 MacDade Blvd Collingdale PA 19023 General Provider Delaware Clark Tanner 015469 Ameri Dental Group PC 875 Main Street Darby PA 19023 General Provider Delaware Patel Amish 015469 Ameri Dental Group PC 875 Main Street Darby PA 19023 General Provider Delaware Patel Prafulchandra 015469 Ameri Dental Group PC 875 Main Street Darby PA 19023 General Provider Delaware Tewari Dinesh 069540 Drexel Hill Family Dentistry PC 4244 Ferne Blvd Drexel Hill PA 19026 General Provider Delaware Kaye Melvin 000752 Melvin A Kaye DDS 2237 Garrett Rd. Drexel Hill PA 19026 Endodontist Delaware Bahram Ramin 078259 Oral Surgery Consultants of PA 720 Macdade Boulevard Folsom PA 19033 Oral Surgeon Delaware Bowser Daniel 078259 Oral Surgery Consultants of PA 720 Macdade Boulevard Folsom PA 19033 Oral Surgeon Delaware Richman Brad 078259 Oral Surgery Consultants of PA 720 Macdade Boulevard Folsom PA 19033 Oral Surgeon Delaware Mongiovi Vincent 002234 Mongiovi Orthodontics 4 Woodland Drive Glen Mills PA 19342 Orthodontist Delaware Wadenya Rose 081804 Eagle Crest Pediatric Dentistry 31 S Eagle Rd, Suite 100 Havertown PA 19083 Pedodontist Delaware Wank Harvey 000824 Harvey A. Wank, D.M.D. 525 West Chester Pike, Suite 100 Havertown PA 19083 Oral Surgeon Delaware Shafagh Iraj 001320 Iraj Shafagh, D.M.D. 109 North Eagle Rd. Havertown PA 19083 General Provider Delaware Mostatab Rebecca 002140 Smile By Design 1330 W Chester Pike Havertown PA 19083 General Provider Delaware Cooper Joel 000992 Ameri Dental Group PC 43 S Lansdowne Ave. Lansdowne PA 19050 General Provider Delaware Patel Amish 000992 Ameri Dental Group PC 43 S Lansdowne Ave. Lansdowne PA 19050 General Provider Delaware Patel Prafulchandra 000992 Ameri Dental Group PC 43 S Lansdowne Ave. Lansdowne PA 19050 General Provider Delaware Adams Michael 002801 American Dental Care, PC 1003 W Baltimore Pike Media PA 19063 General Provider Delaware Blumenthal Edan 002801 American Dental Care, PC 1003 W Baltimore Pike Media PA 19063 General Provider Delaware Blumenthal Mitchel 002801 American Dental Care, PC 1003 W Baltimore Pike Media PA 19063 General Provider Delaware Bruno Frank 002801 American Dental Care, PC 1003 W Baltimore Pike Media PA 19063 Endodontist Delaware Chen Yang 002801 American Dental Care, PC 1003 W Baltimore Pike Media PA 19063 General Provider Delaware Cohen Hal 002801 American Dental Care, PC 1003 W Baltimore Pike Media PA 19063 General Provider Delaware Daly Gerald 002801 American Dental Care, PC 1003 W Baltimore Pike Media PA 19063 General Provider Delaware David Dan 002801 American Dental Care, PC 1003 W Baltimore Pike Media PA 19063 General Provider Delaware Edmonds R Blake 002801 American Dental Care, PC 1003 W Baltimore Pike Media PA 19063 General Provider Delaware Elkhatib Mohammad 002801 American Dental Care, PC 1003 W Baltimore Pike Media PA 19063 General Provider Delaware Fluhr Howard 002801 American Dental Care, PC 1003 W Baltimore Pike Media PA 19063 General Provider Delaware Gelbart Steven 002801 American Dental Care, PC 1003 W Baltimore Pike Media PA 19063 General Provider Delaware Gilkey William 002801 American Dental Care, PC 1003 W Baltimore Pike Media PA 19063 General Provider Delaware Khan Aliya 002801 American Dental Care, PC 1003 W Baltimore Pike Media PA 19063 General Provider Delaware Kim Jae Woo 002801 American Dental Care, PC 1003 W Baltimore Pike Media PA 19063 General Provider Delaware Kim Steven 002801 American Dental Care, PC 1003 W Baltimore Pike Media PA 19063 Periodontist Delaware Koff Howard 002801 American Dental Care, PC 1003 W Baltimore Pike Media PA 19063 Orthodontist Delaware Levy Jamie 002801 American Dental Care, PC 1003 W Baltimore Pike Media PA 19063 Oral Surgeon Delaware Li Fuming 002801 American Dental Care, PC 1003 W Baltimore Pike Media PA 19063 General Provider Delaware Lu John 002801 American Dental Care, PC 1003 W Baltimore Pike Media PA 19063 Periodontist Delaware Mojahed Amir 002801 American Dental Care, PC 1003 W Baltimore Pike Media PA 19063 General Provider Delaware Mumtaz Samera 002801 American Dental Care, PC 1003 W Baltimore Pike Media PA 19063 General Provider Delaware Nguyen Diep 002801 American Dental Care, PC 1003 W Baltimore Pike Media PA 19063 General Provider Delaware Oh Jinsuk 002801 American Dental Care, PC 1003 W Baltimore Pike Media PA 19063 General Provider Delaware Parakhoodi Shabnam 002801 American Dental Care, PC 1003 W Baltimore Pike Media PA 19063 General Provider Delaware Pereia Christine 002801 American Dental Care, PC 1003 W Baltimore Pike Media PA 19063 General Provider Delaware Roth Michael 002801 American Dental Care, PC 1003 W Baltimore Pike Media PA 19063 Orthodontist Delaware Ruggieri John 002801 American Dental Care, PC 1003 W Baltimore Pike Media PA 19063 General Provider Delaware Sacks Frederick 002801 American Dental Care, PC 1003 W Baltimore Pike Media PA 19063 Oral Surgeon Delaware Sandhu Satinder 002801 American Dental Care, PC 1003 W Baltimore Pike Media PA 19063 General Provider Delaware Sanfacon Dennis 002801 American Dental Care, PC 1003 W Baltimore Pike Media PA 19063 General Provider Delaware Shah Nishit 002801 American Dental Care, PC 1003 W Baltimore Pike Media PA 19063 General Provider Delaware Sultana Parveen 002801 American Dental Care, PC 1003 W Baltimore Pike Media PA 19063 General Provider Delaware * Indicates dentist that is accepting current patients only. All Select Plan Dentists Page 23 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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