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 />
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.
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