Select Plan Provider Directory - Dominion Dental Services, Inc.
Select Plan Provider Directory - Dominion Dental Services, Inc.
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 />
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.
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