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 Genkin Alexander 069968 Dentex Dental Group Ltd 1625 Chestnut St, Suite 228 Philadelphia PA 19103 General Provider Philadelphia Go Satoshi 069968 Dentex Dental Group Ltd 1625 Chestnut St, Suite 228 Philadelphia PA 19103 General Provider Philadelphia Joo Esther 069968 Dentex Dental Group Ltd 1625 Chestnut St, Suite 228 Philadelphia PA 19103 General Provider Philadelphia Kim Nari 069968 Dentex Dental Group Ltd 1625 Chestnut St, Suite 228 Philadelphia PA 19103 General Provider Philadelphia Levites Margarita 069968 Dentex Dental Group Ltd 1625 Chestnut St, Suite 228 Philadelphia PA 19103 General Provider Philadelphia Moon Daeuk 069968 Dentex Dental Group Ltd 1625 Chestnut St, Suite 228 Philadelphia PA 19103 General Provider Philadelphia Plotnik Igor 069968 Dentex Dental Group Ltd 1625 Chestnut St, Suite 228 Philadelphia PA 19103 General Provider Philadelphia Sedaghat Shabnam 069968 Dentex Dental Group Ltd 1625 Chestnut St, Suite 228 Philadelphia PA 19103 General Provider Philadelphia Zhang Chengfeng 069968 Dentex Dental Group Ltd 1625 Chestnut St, Suite 228 Philadelphia PA 19103 General Provider Philadelphia Zilberman Alexander 069968 Dentex Dental Group Ltd 1625 Chestnut St, Suite 228 Philadelphia PA 19103 General Provider Philadelphia Yurovsky Renee 038098 Renee Yurovsky DDS PC 1831 Chestnut St, Suite 100 Philadelphia PA 19103 General Provider Philadelphia Wolgin Joshua 079085 Wolgin Endodontic Group 255 S 17th St, Suite 1806 Philadelphia PA 19103 Endodontist Philadelphia Young Eugene 069549 Dr Young & Associates LLC 4310 Walnut St Philadelphia PA 19104 General Provider Philadelphia Yanez Rafael 068457 All About Your Smile PC 200 Walnut St Philadelphia PA 19106 General Provider Philadelphia Adams Michael 002792 American Dental Care, PC 722 Market Street Philadelphia PA 19106 General Provider Philadelphia Blumenthal Mitchel 002792 American Dental Care, PC 722 Market Street Philadelphia PA 19106 General Provider Philadelphia Bruno Frank 002792 American Dental Care, PC 722 Market Street Philadelphia PA 19106 Endodontist Philadelphia Chen Yang 002792 American Dental Care, PC 722 Market Street Philadelphia PA 19106 General Provider Philadelphia Cohen Hal 002792 American Dental Care, PC 722 Market Street Philadelphia PA 19106 General Provider Philadelphia Daly Gerald 002792 American Dental Care, PC 722 Market Street Philadelphia PA 19106 General Provider Philadelphia David Dan 002792 American Dental Care, PC 722 Market Street Philadelphia PA 19106 General Provider Philadelphia Edmonds R Blake 002792 American Dental Care, PC 722 Market Street Philadelphia PA 19106 General Provider Philadelphia Elkhatib Mohammad 002792 American Dental Care, PC 722 Market Street Philadelphia PA 19106 General Provider Philadelphia Fluhr Howard 002792 American Dental Care, PC 722 Market Street Philadelphia PA 19106 General Provider Philadelphia Gelbart Steven 002792 American Dental Care, PC 722 Market Street Philadelphia PA 19106 General Provider Philadelphia Kim Jae Woo 002792 American Dental Care, PC 722 Market Street Philadelphia PA 19106 General Provider Philadelphia Kim Steven 002792 American Dental Care, PC 722 Market Street Philadelphia PA 19106 Periodontist Philadelphia Koff Howard 002792 American Dental Care, PC 722 Market Street Philadelphia PA 19106 Orthodontist Philadelphia Levy Jamie 002792 American Dental Care, PC 722 Market Street Philadelphia PA 19106 Oral Surgeon Philadelphia Li Fuming 002792 American Dental Care, PC 722 Market Street Philadelphia PA 19106 General Provider Philadelphia Lu John 002792 American Dental Care, PC 722 Market Street Philadelphia PA 19106 Periodontist Philadelphia Mojahed Amir 002792 American Dental Care, PC 722 Market Street Philadelphia PA 19106 General Provider Philadelphia Mumtaz Samera 002792 American Dental Care, PC 722 Market Street Philadelphia PA 19106 General Provider Philadelphia Nguyen Diep 002792 American Dental Care, PC 722 Market Street Philadelphia PA 19106 General Provider Philadelphia Oh Jinsuk 002792 American Dental Care, PC 722 Market Street Philadelphia PA 19106 General Provider Philadelphia Pereia Christine 002792 American Dental Care, PC 722 Market Street Philadelphia PA 19106 General Provider Philadelphia Roth Michael 002792 American Dental Care, PC 722 Market Street Philadelphia PA 19106 Orthodontist Philadelphia Ruggieri John 002792 American Dental Care, PC 722 Market Street Philadelphia PA 19106 General Provider Philadelphia Sacks Frederick 002792 American Dental Care, PC 722 Market Street Philadelphia PA 19106 Oral Surgeon Philadelphia Sandhu Satinder 002792 American Dental Care, PC 722 Market Street Philadelphia PA 19106 General Provider Philadelphia Sanfacon Dennis 002792 American Dental Care, PC 722 Market Street Philadelphia PA 19106 General Provider Philadelphia Shah Nishit 002792 American Dental Care, PC 722 Market Street Philadelphia PA 19106 General Provider Philadelphia Shamseddin Seyed 002792 American Dental Care, PC 722 Market Street Philadelphia PA 19106 Periodontist Philadelphia Sultana Parveen 002792 American Dental Care, PC 722 Market Street Philadelphia PA 19106 General Provider Philadelphia Thilak Preetha 002792 American Dental Care, PC 722 Market Street Philadelphia PA 19106 General Provider Philadelphia Weinstein Steven 002792 American Dental Care, PC 722 Market Street Philadelphia PA 19106 General Provider Philadelphia Yang Qing 002792 American Dental Care, PC 722 Market Street Philadelphia PA 19106 General Provider Philadelphia Yao Zheng 002792 American Dental Care, PC 722 Market Street Philadelphia PA 19106 General Provider Philadelphia Yoon Simon 002792 American Dental Care, PC 722 Market Street Philadelphia PA 19106 General Provider Philadelphia Ghani Mohammad 002261 Advance Dental Care Consultants 1225 Vine Street, Suite 401 Philadelphia PA 19107 General Provider Philadelphia * Young Eugene 001194 Dr Young & Associates LLC 924 Arch St. Philadelphia PA 19107 General Provider Philadelphia Paul Prolay 050725 Gallery Mall Dental PC 901 Market St, Space 3220 Philadelphia PA 19107 General Provider Philadelphia Shah Shreyas 050725 Gallery Mall Dental PC 901 Market St, Space 3220 Philadelphia PA 19107 General Provider Philadelphia Cho Sung 050455 Jefferson Oral & Maxillofacial Surgery 909 Walnut St, Suite 300 COB Philadelphia PA 19107 Oral Surgeon Philadelphia Diecidue Robert 050455 Jefferson Oral & Maxillofacial Surgery 909 Walnut St, Suite 300 COB Philadelphia PA 19107 Oral Surgeon Philadelphia Taub Daniel 050455 Jefferson Oral & Maxillofacial Surgery 909 Walnut St, Suite 300 COB Philadelphia PA 19107 Oral Surgeon Philadelphia Bahram Ramin 078260 Oral Surgery Consultants of PA 1601 Walnut Street, Suite 1207 Philadelphia PA 19107 Oral Surgeon Philadelphia Bowser Daniel 078260 Oral Surgery Consultants of PA 1601 Walnut Street, Suite 1207 Philadelphia PA 19107 Oral Surgeon Philadelphia Richman Brad 078260 Oral Surgery Consultants of PA 1601 Walnut Street, Suite 1207 Philadelphia PA 19107 Oral Surgeon Philadelphia Donskoy Jennifer 051123 DentaLux LLC 1308 Cottman Ave Philadelphia PA 19111 General Provider Philadelphia Goldberg Robert 051123 DentaLux LLC 1308 Cottman Ave Philadelphia PA 19111 General Provider Philadelphia Aranbayev Yefim 069969 Dentex Dental Group Ltd 6227 Rising Sun Ave Philadelphia PA 19111 General Provider Philadelphia Choi Bokyu 069969 Dentex Dental Group Ltd 6227 Rising Sun Ave Philadelphia PA 19111 General Provider Philadelphia Cohen Ronald 069969 Dentex Dental Group Ltd 6227 Rising Sun Ave Philadelphia PA 19111 General Provider Philadelphia Genkin Alexander 069969 Dentex Dental Group Ltd 6227 Rising Sun Ave Philadelphia PA 19111 General Provider Philadelphia Go Satoshi 069969 Dentex Dental Group Ltd 6227 Rising Sun Ave Philadelphia PA 19111 General Provider Philadelphia * Indicates dentist that is accepting current patients only. All Select Plan Dentists Page 32 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 Joo Esther 069969 Dentex Dental Group Ltd 6227 Rising Sun Ave Philadelphia PA 19111 General Provider Philadelphia Kim Nari 069969 Dentex Dental Group Ltd 6227 Rising Sun Ave Philadelphia PA 19111 General Provider Philadelphia Levites Margarita 069969 Dentex Dental Group Ltd 6227 Rising Sun Ave Philadelphia PA 19111 General Provider Philadelphia Moon Daeuk 069969 Dentex Dental Group Ltd 6227 Rising Sun Ave Philadelphia PA 19111 General Provider Philadelphia Plotnik Igor 069969 Dentex Dental Group Ltd 6227 Rising Sun Ave Philadelphia PA 19111 General Provider Philadelphia Sedaghat Shabnam 069969 Dentex Dental Group Ltd 6227 Rising Sun Ave Philadelphia PA 19111 General Provider Philadelphia Zhang Chengfeng 069969 Dentex Dental Group Ltd 6227 Rising Sun Ave Philadelphia PA 19111 General Provider Philadelphia Zilberman Alexander 069969 Dentex Dental Group Ltd 6227 Rising Sun Ave Philadelphia PA 19111 General Provider Philadelphia Chadhalavada Kavitha 068449 Eastern Dental Associates of Cottman Avenue 1936 Cottman Ave Philadelphia PA 19111 General Provider Philadelphia Vora Vasant 000838 Vasant K. Vora, D.D.S. 907 Tyson Ave, PO Box 11436 Philadelphia PA 19111 General Provider Philadelphia Adams Michael 002797 American Dental Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General Provider Philadelphia Blumenthal Mitchel 002797 American Dental Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General Provider Philadelphia Bruno Frank 002797 American Dental Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 Endodontist Philadelphia Chen Yang 002797 American Dental Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General Provider Philadelphia Cohen Hal 002797 American Dental Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General Provider Philadelphia Daly Gerald 002797 American Dental Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General Provider Philadelphia David Dan 002797 American Dental Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General Provider Philadelphia Edmonds R Blake 002797 American Dental Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General Provider Philadelphia Elkhatib Mohammad 002797 American Dental Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General Provider Philadelphia Fluhr Howard 002797 American Dental Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General Provider Philadelphia Gelbart Steven 002797 American Dental Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General Provider Philadelphia Kim Jae Woo 002797 American Dental Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General Provider Philadelphia Kim Steven 002797 American Dental Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 Periodontist Philadelphia Koff Howard 002797 American Dental Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 Orthodontist Philadelphia Levy Jamie 002797 American Dental Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 Oral Surgeon Philadelphia Li Fuming 002797 American Dental Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General Provider Philadelphia Lu John 002797 American Dental Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 Periodontist Philadelphia Mojahed Amir 002797 American Dental Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General Provider Philadelphia Mumtaz Samera 002797 American Dental Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General Provider Philadelphia Nguyen Diep 002797 American Dental Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General Provider Philadelphia Oh Jinsuk 002797 American Dental Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General Provider Philadelphia Pereia Christine 002797 American Dental Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General Provider Philadelphia Roth Michael 002797 American Dental Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 Orthodontist Philadelphia Ruggieri John 002797 American Dental Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General Provider Philadelphia Sacks Frederick 002797 American Dental Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 Oral Surgeon Philadelphia Sandhu Satinder 002797 American Dental Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General Provider Philadelphia Sanfacon Dennis 002797 American Dental Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General Provider Philadelphia Shah Nishit 002797 American Dental Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General Provider Philadelphia Sultana Parveen 002797 American Dental Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General Provider Philadelphia Thilak Preetha 002797 American Dental Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General Provider Philadelphia Weinstein Steven 002797 American Dental Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General Provider Philadelphia Yang Qing 002797 American Dental Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General Provider Philadelphia Yao Zheng 002797 American Dental Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General Provider Philadelphia Yoon Simon 002797 American Dental Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General Provider Philadelphia Bresler David 001580 David A Bresler DDS PC 240 Geiger Rd. Philadelphia PA 19115 Pedodontist Philadelphia Bresler Jason 001580 David A Bresler DDS PC 240 Geiger Rd. Philadelphia PA 19115 Pedodontist Philadelphia Bresler Joshua 001580 David A Bresler DDS PC 240 Geiger Rd. Philadelphia PA 19115 Pedodontist Philadelphia Mayzenberg Julia 001580 David A Bresler DDS PC 240 Geiger Rd. Philadelphia PA 19115 Pedodontist Philadelphia Bresler David 078265 Doc Breslers Cavity Busters 1916 Welsh Rd Philadelphia PA 19115 Pedodontist Philadelphia Bresler Jason 078265 Doc Breslers Cavity Busters 1916 Welsh Rd Philadelphia PA 19115 Pedodontist Philadelphia Bresler Joshua 078265 Doc Breslers Cavity Busters 1916 Welsh Rd Philadelphia PA 19115 Pedodontist Philadelphia Jacobson Irving 078265 Doc Breslers Cavity Busters 1916 Welsh Rd Philadelphia PA 19115 Pedodontist Philadelphia Mayzenberg Julia 078265 Doc Breslers Cavity Busters 1916 Welsh Rd Philadelphia PA 19115 Pedodontist Philadelphia Uppal Gagan 050646 AC Dental of NE Philly 10000 Roosevelt Blvd Philadelphia PA 19116 General Provider Philadelphia Burdo Gregory 069987 Da Vinci Dental Specialists 10108 Bustleton Ave Philadelphia PA 19116 Periodontist Philadelphia Aranbayev Yefim 069572 Dentex Dental Group Ltd 10108 Bustleton Ave Philadelphia PA 19116 General Provider Philadelphia Choi Bokyu 069572 Dentex Dental Group Ltd 10108 Bustleton Ave Philadelphia PA 19116 General Provider Philadelphia Cohen Ronald 069572 Dentex Dental Group Ltd 10108 Bustleton Ave Philadelphia PA 19116 General Provider Philadelphia Genkin Alexander 069572 Dentex Dental Group Ltd 10108 Bustleton Ave Philadelphia PA 19116 General Provider Philadelphia Go Satoshi 069572 Dentex Dental Group Ltd 10108 Bustleton Ave Philadelphia PA 19116 General Provider Philadelphia Joo Esther 069572 Dentex Dental Group Ltd 10108 Bustleton Ave Philadelphia PA 19116 General Provider Philadelphia Kim Nari 069572 Dentex Dental Group Ltd 10108 Bustleton Ave Philadelphia PA 19116 General Provider Philadelphia Levites Margarita 069572 Dentex Dental Group Ltd 10108 Bustleton Ave Philadelphia PA 19116 General Provider Philadelphia Moon Daeuk 069572 Dentex Dental Group Ltd 10108 Bustleton Ave Philadelphia PA 19116 General Provider Philadelphia Plotnik Igor 069572 Dentex Dental Group Ltd 10108 Bustleton Ave Philadelphia PA 19116 General Provider Philadelphia Sedaghat Shabnam 069572 Dentex Dental Group Ltd 10108 Bustleton Ave Philadelphia PA 19116 General Provider Philadelphia * Indicates dentist that is accepting current patients only. All Select Plan Dentists Page 33 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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