Select Plan Dentist Directory - Dominion Dental Services, Inc.
Select Plan Dentist Directory - Dominion Dental Services, Inc.
Select Plan Dentist Directory - Dominion Dental Services, Inc.
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SELECT PLAN 1 DENTIST DIRECTORY<br />
<strong>Dentist</strong>s listed are under contract as of 9/1/12<br />
Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />
Lee Richard 000000001058 Richard Lee D.D.S. 214 2nd Street SE Washington DC 20003 General Provider District of Columbia<br />
Penn Shelton 000000000338 Shelton R Penn DDS 5 Barney Circle, S.E. Washington DC 20003 General Provider District of Columbia<br />
El Haje Emad 000000037585 Prosthetic and TMJ Management 1800 I Street, Suite 801 Washington DC 20006 General Provider District of Columbia<br />
Contract Sheldon Sheldon L. Contract, DDS, PC 1800 I Street NW, Suite 402 Washington DC 20006 Orthodontist District of Columbia<br />
Peretz A 000000002739 Georgetown Smile 4400 MacAuthur Blvd., Suite 200 Washington DC 20007 General Provider District of Columbia<br />
Landy Michael 000000000281 Michael G. Landy, D.D.S., F.A.G.D. 4600 Connecticut Ave. N.W. Washington DC 20008 General Provider District of Columbia<br />
Salameh Tareq 000000050841 Salameh <strong>Dental</strong> Associates 4444 Connecticut Ave. NW, Suite 106 Washington DC 20008 General Provider District of Columbia<br />
Sharmin Rahim 000000001691 Sharmin <strong>Dental</strong> Clinic/Rahim Sharmin, D.D.S. 1613 Harvard Street, NW, Suite 108 Washington DC 20009 General Provider District of Columbia<br />
George Delphine 000000050966 Smile <strong>Dental</strong> PC 2108 18th St NW, Suite 1 Washington DC 20009 General Provider District of Columbia<br />
Nallavalli Sravanthi 000000050966 Smile <strong>Dental</strong> PC 2108 18th St NW, Suite 1 Washington DC 20009 General Provider District of Columbia<br />
Said Hoda 000000050966 Smile <strong>Dental</strong> PC 2108 18th St NW, Suite 1 Washington DC 20009 General Provider District of Columbia<br />
Branch, III Maury 000000051048 Petworth <strong>Dental</strong> PLLC 4018 Georgia Ave NW Washington DC 20011 General Provider District of Columbia<br />
Miller Gregory 000000001659 Capitol City <strong>Dental</strong> Center 7723 Alaska Avenue, NW Washington DC 20012 General Provider District of Columbia<br />
Salameh Tareq 000000069560 Eastern Family <strong>Dental</strong> 7826 Eastern Ave NW, Suite 202 Washington DC 20012 General Provider District of Columbia<br />
Perry-Dodson Elizabeth 000000061282 Elizabeth Perry-Dodson DDS 7310 Alaska Ave NW Washington DC 20012 General Provider District of Columbia<br />
Roudsari Monireh 000000002769 Georgia Avenue <strong>Dental</strong> Clinic 7304 Georgia Ave. NW, Suite 2 Washington DC 20012 General Provider District of Columbia<br />
Branch, III Maury 000000051049 Petworth <strong>Dental</strong> PLLC 800 Butternut St NW Washington DC 20012 General Provider District of Columbia<br />
De La Cruz Carola Elidia C Fidel, D.D.S. PLP 5247 Wisconsin Avenue, Suite 3 A Washington DC 20015 Pedodontist District of Columbia<br />
Fidel Elidia Elidia C Fidel, D.D.S. PLP 5247 Wisconsin Avenue, Suite 3 A Washington DC 20015 Pedodontist District of Columbia<br />
Mallek Henry Henry Mallek,D.D.S. 4910 Massachusetts Ave., Suite 219 Washington DC 20016 Periodontist District of Columbia<br />
McNair Larry 000000050740 Larry F McNair DDS 2033 Hamlin Street, NE Washington DC 20018 General Provider District of Columbia<br />
Harrison Eric 000000037679 E G Harrison DMD 3230 Pennsylvania Ave SE Washington DC 20020 General Provider District of Columbia<br />
* Davidson, Jr. Alphonzo 000000000512 Hillcrest <strong>Dental</strong> Assoc. 2811 Pennsylvania Avenue Washington DC 20020 General Provider District of Columbia<br />
Baptiste Roy 000000001406 Roy Baptiste DDS 3130 MLK Ave, S.E. Washington DC 20032 General Provider District of Columbia<br />
Hood, III James 000000001406 Roy Baptiste DDS 3130 MLK Ave, S.E. Washington DC 20032 General Provider District of Columbia<br />
Walker Michael 000000001406 Roy Baptiste DDS 3130 MLK Ave, S.E. Washington DC 20032 General Provider District of Columbia<br />
Lasky Andrew 000000000185 Andrew M. Lasky, D.D.S., P.C. 1325 18th St. N.W. #201 Washington DC 20036 General Provider District of Columbia<br />
Gitelman Jeffrey Jeffrey Gitelman, D.D.S., P.C. 1234 19th St. N.W., Ste. 508 Washington DC 20036 Oral Surgeon District of Columbia<br />
Merlo Leonard Jeffrey Gitelman, D.D.S., P.C. 1234 19th St. N.W., Ste. 508 Washington DC 20036 Oral Surgeon District of Columbia<br />
Blumenkranz Uziel Uzeil Blumenkranz, D.D.S. 1234 19th Street, Suite 208 Washington DC 20036 Endodontist District of Columbia<br />
Doumit Antoine Antoine Doumit DMD CAGS PC 950 25th St NW Washington DC 20037 Orthodontist District of Columbia<br />
Eshraghi Bahram 000000000273 Yousefi Washington Clinic 3 Washington Circle, Suite G Washington DC 20037 General Provider District of Columbia<br />
Kim Randolph 000000000273 Yousefi Washington Clinic 3 Washington Circle, Suite G Washington DC 20037 General Provider District of Columbia<br />
Palizi Alireza 000000000273 Yousefi Washington Clinic 3 Washington Circle, Suite G Washington DC 20037 General Provider District of Columbia<br />
Yousefi Mehdi 000000000273 Yousefi Washington Clinic 3 Washington Circle, Suite G Washington DC 20037 General Provider District of Columbia<br />
Choudhri Sobia 000000033836 American <strong>Dental</strong> Care of Dover LLC 65 North DuPont Hwy Dover DE 19901 General Provider Kent<br />
Medlin Tawana 000000033836 American <strong>Dental</strong> Care of Dover LLC 65 North DuPont Hwy Dover DE 19901 General Provider Kent<br />
Patel Amit 000000033836 American <strong>Dental</strong> Care of Dover LLC 65 North DuPont Hwy Dover DE 19901 General Provider Kent<br />
Patel Prafulchandra 000000033836 American <strong>Dental</strong> Care of Dover LLC 65 North DuPont Hwy Dover DE 19901 General Provider Kent<br />
Russo John 000000033836 American <strong>Dental</strong> Care of Dover LLC 65 North DuPont Hwy Dover DE 19901 General Provider Kent<br />
Russo Nicholas 000000033836 American <strong>Dental</strong> Care of Dover LLC 65 North DuPont Hwy Dover DE 19901 General Provider Kent<br />
Veith Charles Charles J Veith DMD PA MS 748 S. New Street Dover DE 19901 Orthodontist Kent<br />
* Fay Daniel 000000033837 Arthur W Henry DDS PA 748 S. New Street Dover DE 19904 General Provider Kent<br />
* Henry Arthur 000000033837 Arthur W Henry DDS PA 748 S. New Street Dover DE 19904 General Provider Kent<br />
Pancko Franklin Dover Oral and Maxillofacial Surgery 712 S. Governors Avenue Dover DE 19904 Oral Surgeon Kent<br />
Pillsbury James 000000079087 James S Pillsbury DDS 125 Greentree Dr, Suite 2 Dover DE 19904 General Provider Kent<br />
Fagioletti Lisa 000000061387 Lisa A Fagioletti DMD LLC 25 W Commerce St Smyrna DE 19977 General Provider Kent<br />
Cook Jeffrey 000000001466 Jeffrey L Cook DMD PA 16 Peddlers Village Christiana DE 19702 General Provider New Castle<br />
Cook G Leigh 000000001465 Cook Family <strong>Dentist</strong>ry LLC 12 Pennington Street, Suite 300 Middletown DE 19709 General Provider New Castle<br />
Cook Megan 000000001465 Cook Family <strong>Dentist</strong>ry LLC 12 Pennington Street, Suite 300 Middletown DE 19709 General Provider New Castle<br />
Recktenwald William 000000001899 Christiana <strong>Dental</strong> Center 330 Christiana Medical Center Newark DE 19702 General Provider New Castle<br />
* Duffy Michael 000000002860 Park Place <strong>Dental</strong> 210 West Park Place Newark DE 19711 General Provider New Castle<br />
* Kuipers Edwin 000000002860 Park Place <strong>Dental</strong> 210 West Park Place Newark DE 19711 General Provider New Castle<br />
* Russo Nicholas 000000002860 Park Place <strong>Dental</strong> 210 West Park Place Newark DE 19711 General Provider New Castle<br />
D'Amico, III Eugene Eugene M. D'Amico, III, D.D.S. 4735 Ogletown-Stanton Road, Suite 1115 Newark DE 19713 Oral Surgeon New Castle<br />
Le Hung 000000050875 Premier <strong>Dentist</strong>ry of Christiana 4745 Ogletown-Stanton Rd, Suite 110 Newark DE 19713 General Provider New Castle<br />
Fink Fred Fred S. Fink, D.D.S. 3518 Silverside Rd, 23 The Commons Wilmington DE 19801 Orthodontist New Castle<br />
* Bayley Amanda 000000001474 Progressive <strong>Dental</strong> Arts 217 W. Ninth Street Wilmington DE 19801 General Provider New Castle<br />
* Nguyen Alan 000000001474 Progressive <strong>Dental</strong> Arts 217 W. Ninth Street Wilmington DE 19801 General Provider New Castle<br />
* Wu Lavinia 000000001474 Progressive <strong>Dental</strong> Arts 217 W. Ninth Street Wilmington DE 19801 General Provider New Castle<br />
* Hertzfeld Edward 000000001467 E.J. Hertzfeld, D.D.S., P.A. 1900 Washington Street Wilmington DE 19802 General Provider New Castle<br />
* Duffy Michael 000000001455 Foulk Road <strong>Dental</strong> 300 Foulk Road Wilmington DE 19803 General Provider New Castle<br />
* Kuipers Edwin 000000001455 Foulk Road <strong>Dental</strong> 300 Foulk Road Wilmington DE 19803 General Provider New Castle<br />
* Russo John 000000001455 Foulk Road <strong>Dental</strong> 300 Foulk Road Wilmington DE 19803 General Provider New Castle<br />
* Russo Nicholas 000000001455 Foulk Road <strong>Dental</strong> 300 Foulk Road Wilmington DE 19803 General Provider New Castle<br />
Klassman Bradford Delaware Periodontics 1110 N. Bancroft Parkway Wilmington DE 19805 Periodontist New Castle<br />
* Indicates dentist that is accepting current patients only.<br />
All <strong>Select</strong> <strong>Plan</strong> <strong>Dentist</strong>s Page 1<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 <strong>Dentist</strong>. Fac ID is used to indicate which facility a member chooses.
SELECT PLAN 1 DENTIST DIRECTORY<br />
<strong>Dentist</strong>s listed are under contract as of 9/1/12<br />
Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />
Baker Elizabeth 000000002476 Westside Health 1802 W Fourth St Wilmington DE 19805 General Provider New Castle<br />
Kubasko MaryClare 000000002476 Westside Health 1802 W Fourth St Wilmington DE 19805 General Provider New Castle<br />
Swiatowicz Andrew 000000002476 Westside Health 1802 W Fourth St Wilmington DE 19805 General Provider New Castle<br />
Nguyen Keith 000000001510 Aesthetic & Special Care Associates PA 2323 Pennsylvania Avenue Wilmington DE 19806 General Provider New Castle<br />
Veith Charles Charles J Veith DMD PA MS 2300 Pennsylvania Avenue Wilmington DE 19806 Orthodontist New Castle<br />
* Sweeney, III Patrick 000000002753 Healthy Smiles of Delaware, P.A. 1700 Shall Cross Ave., Suite 2 Wilmington DE 19806 General Provider New Castle<br />
* Casalena Herbert 000000001463 Herbert T. Casalena, D.D.S., P.A. 2300 Pennsylvania Avenue, 6th floor Wilmington DE 19806 General Provider New Castle<br />
* Hounsell Jill 000000001463 Herbert T. Casalena, D.D.S., P.A. 2300 Pennsylvania Avenue, 6th floor Wilmington DE 19806 General Provider New Castle<br />
Kim Jung Kreshtool & Kim Endodontics PA 1815 West 13th Street, Suite 7 Wilmington DE 19806 Endodontist New Castle<br />
Kreshtool Daniel Kreshtool & Kim Endodontics PA 1815 West 13th Street, Suite 7 Wilmington DE 19806 Endodontist New Castle<br />
* Rybinski John 000000001460 John F. Rybinski, D.D.S. 2601 Annand Drive, Suite 6 Wilmington DE 19808 General Provider New Castle<br />
Elkington I 000000033877 Seaford <strong>Dental</strong> Associates 218 Pennsylvania Ave Seaford DE 19973 General Provider Sussex<br />
Baskies Robert 000000002093 Robert Baskies, D.M.D. 109 Washington Avenue Chelsea MA 02150 General Provider Suffolk<br />
* Laparle Frank 000000000454 Frank A. Laparle, D.D.S. 500 Memorial Ave., #401 Cumberland MD 21502 General Provider Allegany<br />
* Brodell Lynne 000000000429 Lynne S. Brodell, D.D.S. 12600 Winchester Rd. #103 LaVale MD 21502 General Provider Allegany<br />
Labbe Stephen Stewart & Labbe, D.D.S., P.A. 101 Ridgely Ave., Suite 21 Annapolis MD 21401 Orthodontist Anne Arundel<br />
Stewart Lamon Stewart & Labbe, D.D.S., P.A. 101 Ridgely Ave., Suite 21 Annapolis MD 21401 Orthodontist Anne Arundel<br />
Hlousek Lubor Walzer Sullivan and Hlousek PA 101 Ridgely Avenue, Suite 21 Annapolis MD 21401 Oral Surgeon Anne Arundel<br />
Jones Kurt Walzer Sullivan and Hlousek PA 101 Ridgely Avenue, Suite 21 Annapolis MD 21401 Oral Surgeon Anne Arundel<br />
Sullivan Cornelius Walzer Sullivan and Hlousek PA 101 Ridgely Avenue, Suite 21 Annapolis MD 21401 Oral Surgeon Anne Arundel<br />
Walzer Clifford Walzer Sullivan and Hlousek PA 101 Ridgely Avenue, Suite 21 Annapolis MD 21401 Oral Surgeon Anne Arundel<br />
Granek Warren Warren Granek DDS 1410 Forest Dr, Suite 29 Annapolis MD 21403 Orthodontist Anne Arundel<br />
Hlousek Lubor Walzer Sullivan and Hlousek PA 275 West St, Suite 100 Annapolis MD 21404 Oral Surgeon Anne Arundel<br />
Jones Kurt Walzer Sullivan and Hlousek PA 275 West St, Suite 100 Annapolis MD 21404 Oral Surgeon Anne Arundel<br />
Sullivan Cornelius Walzer Sullivan and Hlousek PA 275 West St, Suite 100 Annapolis MD 21404 Oral Surgeon Anne Arundel<br />
Walzer Clifford Walzer Sullivan and Hlousek PA 275 West St, Suite 100 Annapolis MD 21404 Oral Surgeon Anne Arundel<br />
Heller Alan Alan R Heller DDS Ms 2200 Defense Highway, Suite 208 Crofton MD 21114 Orthodontist Anne Arundel<br />
Batrouni Ziad Maryland Oral Surgery Associates 1667 Crofton Centre, Suite 7A Crofton MD 21114 Oral Surgeon Anne Arundel<br />
Cohen Lisa Maryland Oral Surgery Associates 1667 Crofton Centre, Suite 7A Crofton MD 21114 Oral Surgeon Anne Arundel<br />
Griffith Miari-Ann Maryland Oral Surgery Associates 1667 Crofton Centre, Suite 7A Crofton MD 21114 Oral Surgeon Anne Arundel<br />
Kashyap Anil Maryland Oral Surgery Associates 1667 Crofton Centre, Suite 7A Crofton MD 21114 Oral Surgeon Anne Arundel<br />
Patel Chirag Maryland Oral Surgery Associates 1667 Crofton Centre, Suite 7A Crofton MD 21114 Oral Surgeon Anne Arundel<br />
Robinson Brian Maryland Oral Surgery Associates 1667 Crofton Centre, Suite 7A Crofton MD 21114 Oral Surgeon Anne Arundel<br />
Stark Mitchell Maryland Oral Surgery Associates 1667 Crofton Centre, Suite 7A Crofton MD 21114 Oral Surgeon Anne Arundel<br />
Trinh Huy Maryland Oral Surgery Associates 1667 Crofton Centre, Suite 7A Crofton MD 21114 Oral Surgeon Anne Arundel<br />
Criscitiello Kevin 000000000479 Ulery <strong>Dental</strong> & Orthodontics 1286 MD Rt. 3 South, Suite 7 Crofton MD 21114 General Provider Anne Arundel<br />
DeMizio Peter Ulery <strong>Dental</strong> & Orthodontics 1286 MD Rt. 3 South, Suite 7 Crofton MD 21114 Oral Surgeon Anne Arundel<br />
Elrafei Mohamed 000000000479 Ulery <strong>Dental</strong> & Orthodontics 1286 MD Rt. 3 South, Suite 7 Crofton MD 21114 General Provider Anne Arundel<br />
Ganjavian Babak 000000000479 Ulery <strong>Dental</strong> & Orthodontics 1286 MD Rt. 3 South, Suite 7 Crofton MD 21114 General Provider Anne Arundel<br />
Gentile Michael Ulery <strong>Dental</strong> & Orthodontics 1286 MD Rt. 3 South, Suite 7 Crofton MD 21114 Oral Surgeon Anne Arundel<br />
Ghajarnia Katayoun 000000000479 Ulery <strong>Dental</strong> & Orthodontics 1286 MD Rt. 3 South, Suite 7 Crofton MD 21114 General Provider Anne Arundel<br />
Ghajarnia M. Reza Ulery <strong>Dental</strong> & Orthodontics 1286 MD Rt. 3 South, Suite 7 Crofton MD 21114 Orthodontist Anne Arundel<br />
Jun Sung 000000000479 Ulery <strong>Dental</strong> & Orthodontics 1286 MD Rt. 3 South, Suite 7 Crofton MD 21114 General Provider Anne Arundel<br />
Mankiewicz Ryan 000000000479 Ulery <strong>Dental</strong> & Orthodontics 1286 MD Rt. 3 South, Suite 7 Crofton MD 21114 General Provider Anne Arundel<br />
Masood Arif 000000000479 Ulery <strong>Dental</strong> & Orthodontics 1286 MD Rt. 3 South, Suite 7 Crofton MD 21114 General Provider Anne Arundel<br />
Steinberg Wayne 000000000479 Ulery <strong>Dental</strong> & Orthodontics 1286 MD Rt. 3 South, Suite 7 Crofton MD 21114 General Provider Anne Arundel<br />
Tchakarova Ludmila 000000000479 Ulery <strong>Dental</strong> & Orthodontics 1286 MD Rt. 3 South, Suite 7 Crofton MD 21114 General Provider Anne Arundel<br />
Ulery Scott 000000000479 Ulery <strong>Dental</strong> & Orthodontics 1286 MD Rt. 3 South, Suite 7 Crofton MD 21114 General Provider Anne Arundel<br />
Weiss Karl Ulery <strong>Dental</strong> & Orthodontics 1286 MD Rt. 3 South, Suite 7 Crofton MD 21114 Orthodontist Anne Arundel<br />
Wolf Christopher 000000000479 Ulery <strong>Dental</strong> & Orthodontics 1286 MD Rt. 3 South, Suite 7 Crofton MD 21114 General Provider Anne Arundel<br />
Granek Warren Warren Granek DDS 3143 Solomns Island Rd Edgewater MD 21037 Orthodontist Anne Arundel<br />
Muko Deep 000000002216 Gambrills Family <strong>Dentist</strong>ry 959 Annapolis Road Gambrills MD 21054 General Provider Anne Arundel<br />
Mekouar Hicham Gambrills Orthodontics 331 Gambrills Rd, Suite 7 Gambrills MD 21054 Orthodontist Anne Arundel<br />
Garfinkel Allan Allan V. Garfinkle, D.D.S. 300 Hospital Drive #237 Glen Burnie MD 21061 Oral Surgeon Anne Arundel<br />
Goldman Stephen Drs. Goldman and Packman 7600 Ritchie Hwy Glen Burnie MD 21061 Periodontist Anne Arundel<br />
Anyadike Anthony Greenway Orthodontics, LLC 30 Greenway St. NW, Suite 4 Glen Burnie MD 21061 Orthodontist Anne Arundel<br />
Packman Harold Harold Packman, D.M.D., PA 7600 Ritchie Hwy. Glen Burnie MD 21061 Periodontist Anne Arundel<br />
Exposito Jacques 000000017299 Jacques P Exposito DDS 1404 Crain Highway South, Suite 110 Glen Burnie MD 21061 General Provider Anne Arundel<br />
Abrahams Heather Orthodontic Associates 7954 Balt-Annapolis Blvd. 2 C Glen Burnie MD 21061 Orthodontist Anne Arundel<br />
Miller Jeffrey Orthodontic Associates 7954 Balt-Annapolis Blvd. 2 C Glen Burnie MD 21061 Orthodontist Anne Arundel<br />
Williams David Orthodontic Associates 7954 Balt-Annapolis Blvd. 2 C Glen Burnie MD 21061 Orthodontist Anne Arundel<br />
Criscitiello Kevin 000000050372 Ulery <strong>Dental</strong> and Orthodontics 7067 Baltimore Annapolis Blvd Glen Burnie MD 21061 General Provider Anne Arundel<br />
DeMizio Peter Ulery <strong>Dental</strong> and Orthodontics 7067 Baltimore Annapolis Blvd Glen Burnie MD 21061 Oral Surgeon Anne Arundel<br />
Elrafei Mohamed 000000050372 Ulery <strong>Dental</strong> and Orthodontics 7067 Baltimore Annapolis Blvd Glen Burnie MD 21061 General Provider Anne Arundel<br />
Ganjavian Babak 000000050372 Ulery <strong>Dental</strong> and Orthodontics 7067 Baltimore Annapolis Blvd Glen Burnie MD 21061 General Provider Anne Arundel<br />
Gentile Michael Ulery <strong>Dental</strong> and Orthodontics 7067 Baltimore Annapolis Blvd Glen Burnie MD 21061 Oral Surgeon Anne Arundel<br />
* Indicates dentist that is accepting current patients only.<br />
All <strong>Select</strong> <strong>Plan</strong> <strong>Dentist</strong>s Page 2<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 <strong>Dentist</strong>. Fac ID is used to indicate which facility a member chooses.
SELECT PLAN 1 DENTIST DIRECTORY<br />
<strong>Dentist</strong>s listed are under contract as of 9/1/12<br />
Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />
Ghajarnia Katayoun 000000050372 Ulery <strong>Dental</strong> and Orthodontics 7067 Baltimore Annapolis Blvd Glen Burnie MD 21061 General Provider Anne Arundel<br />
Ghajarnia M. Reza Ulery <strong>Dental</strong> and Orthodontics 7067 Baltimore Annapolis Blvd Glen Burnie MD 21061 Orthodontist Anne Arundel<br />
Jun Sung 000000050372 Ulery <strong>Dental</strong> and Orthodontics 7067 Baltimore Annapolis Blvd Glen Burnie MD 21061 General Provider Anne Arundel<br />
Mankiewicz Ryan 000000050372 Ulery <strong>Dental</strong> and Orthodontics 7067 Baltimore Annapolis Blvd Glen Burnie MD 21061 General Provider Anne Arundel<br />
Masood Arif 000000050372 Ulery <strong>Dental</strong> and Orthodontics 7067 Baltimore Annapolis Blvd Glen Burnie MD 21061 General Provider Anne Arundel<br />
Tchakarova Ludmila 000000050372 Ulery <strong>Dental</strong> and Orthodontics 7067 Baltimore Annapolis Blvd Glen Burnie MD 21061 General Provider Anne Arundel<br />
Ulery Scott 000000050372 Ulery <strong>Dental</strong> and Orthodontics 7067 Baltimore Annapolis Blvd Glen Burnie MD 21061 General Provider Anne Arundel<br />
Weiss Karl Ulery <strong>Dental</strong> and Orthodontics 7067 Baltimore Annapolis Blvd Glen Burnie MD 21061 Orthodontist Anne Arundel<br />
Wolf Christopher 000000050372 Ulery <strong>Dental</strong> and Orthodontics 7067 Baltimore Annapolis Blvd Glen Burnie MD 21061 General Provider Anne Arundel<br />
Bonebreak David Chesapeake Orthodontics 7556 Teague Rd, Suite 106 Hanover MD 21076 Orthodontist Anne Arundel<br />
* Stephens George 000000000284 George M. Stephens, D.D.S. 3450 Ft. Meade Rd., Suite 211 Laurel MD 20724 General Provider Anne Arundel<br />
* Tehrani Saideh 000000000446 Saideh Tehrani, D.M.D. 3450 Fort Meade Rd. #202, Suite 202 Laurel MD 20724 General Provider Anne Arundel<br />
Sevilla Guevara Maria Childrens <strong>Dentist</strong>ry at Odenton LLC 1215 Annapolis Rd, Suite 106 Odenton MD 21113 Pedodontist Anne Arundel<br />
Winnard Robert Robert G. Winnard, D.M.D. 1215 Annapolis Rd., Suite 207 Odenton MD 21113 Orthodontist Anne Arundel<br />
Clark Maxine Maryland Orthodontic Specialists 8028 Ritchie Hwy, Suite 202 Pasadena MD 21122 Orthodontist Anne Arundel<br />
Criscitiello Kevin 000000002011 Ulery <strong>Dental</strong> & Orthodontics 8055 Ritchie Hwy, Suite 102 Pasadena MD 21122 General Provider Anne Arundel<br />
DeMizio Peter Ulery <strong>Dental</strong> & Orthodontics 8055 Ritchie Hwy, Suite 102 Pasadena MD 21122 Oral Surgeon Anne Arundel<br />
Elrafei Mohamed 000000002011 Ulery <strong>Dental</strong> & Orthodontics 8055 Ritchie Hwy, Suite 102 Pasadena MD 21122 General Provider Anne Arundel<br />
Ganjavian Babak 000000002011 Ulery <strong>Dental</strong> & Orthodontics 8055 Ritchie Hwy, Suite 102 Pasadena MD 21122 General Provider Anne Arundel<br />
Gentile Michael Ulery <strong>Dental</strong> & Orthodontics 8055 Ritchie Hwy, Suite 102 Pasadena MD 21122 Oral Surgeon Anne Arundel<br />
Ghajarnia Katayoun 000000002011 Ulery <strong>Dental</strong> & Orthodontics 8055 Ritchie Hwy, Suite 102 Pasadena MD 21122 General Provider Anne Arundel<br />
Ghajarnia M. Reza Ulery <strong>Dental</strong> & Orthodontics 8055 Ritchie Hwy, Suite 102 Pasadena MD 21122 Orthodontist Anne Arundel<br />
Jun Sung 000000002011 Ulery <strong>Dental</strong> & Orthodontics 8055 Ritchie Hwy, Suite 102 Pasadena MD 21122 General Provider Anne Arundel<br />
Mankiewicz Ryan 000000002011 Ulery <strong>Dental</strong> & Orthodontics 8055 Ritchie Hwy, Suite 102 Pasadena MD 21122 General Provider Anne Arundel<br />
Masood Arif 000000002011 Ulery <strong>Dental</strong> & Orthodontics 8055 Ritchie Hwy, Suite 102 Pasadena MD 21122 General Provider Anne Arundel<br />
Steinberg Wayne 000000002011 Ulery <strong>Dental</strong> & Orthodontics 8055 Ritchie Hwy, Suite 102 Pasadena MD 21122 General Provider Anne Arundel<br />
Tchakarova Ludmila 000000002011 Ulery <strong>Dental</strong> & Orthodontics 8055 Ritchie Hwy, Suite 102 Pasadena MD 21122 General Provider Anne Arundel<br />
Ulery Scott 000000002011 Ulery <strong>Dental</strong> & Orthodontics 8055 Ritchie Hwy, Suite 102 Pasadena MD 21122 General Provider Anne Arundel<br />
Weiss Karl Ulery <strong>Dental</strong> & Orthodontics 8055 Ritchie Hwy, Suite 102 Pasadena MD 21122 Orthodontist Anne Arundel<br />
Wolf Christopher 000000002011 Ulery <strong>Dental</strong> & Orthodontics 8055 Ritchie Hwy, Suite 102 Pasadena MD 21122 General Provider Anne Arundel<br />
Hlousek Lubor Walzer Sullivan and Hlousek PA 8092 Edwin Raynor Blvd. # A Pasadena MD 21122 Oral Surgeon Anne Arundel<br />
Jones Kurt Walzer Sullivan and Hlousek PA 8092 Edwin Raynor Blvd. # A Pasadena MD 21122 Oral Surgeon Anne Arundel<br />
Sullivan Cornelius Walzer Sullivan and Hlousek PA 8092 Edwin Raynor Blvd. # A Pasadena MD 21122 Oral Surgeon Anne Arundel<br />
Walzer Clifford Walzer Sullivan and Hlousek PA 8092 Edwin Raynor Blvd. # A Pasadena MD 21122 Oral Surgeon Anne Arundel<br />
Garden Richard Richard B. Garden, D.D.S. 555 Benfield Road Severna Park MD 21146 Oral Surgeon Anne Arundel<br />
* Bae Hyung Jin <strong>Dental</strong> One Associates Security Blvd LLC 6666 Security Blvd Baltimore MD 21207 Pedodontist Baltimore<br />
* Huynh Thuylinh <strong>Dental</strong> One Associates Security Blvd LLC 6666 Security Blvd Baltimore MD 21207 Orthodontist Baltimore<br />
* Patel Yash 000000061388 <strong>Dental</strong> One Associates Security Blvd LLC 6666 Security Blvd Baltimore MD 21207 General Provider Baltimore<br />
* Seyedsalari Leila 000000061388 <strong>Dental</strong> One Associates Security Blvd LLC 6666 Security Blvd Baltimore MD 21207 General Provider Baltimore<br />
* Thompson Mellanie 000000061388 <strong>Dental</strong> One Associates Security Blvd LLC 6666 Security Blvd Baltimore MD 21207 General Provider Baltimore<br />
Dyson, Jr. Joseph 000000000163 Joseph L. Dyson, Jr., D.D.S. 4901 Liberty Heights Ave. Baltimore MD 21207 General Provider Baltimore<br />
Fried Daniel Daniel I. Fried, D.M.D. 3635 Old Court Rd. #501 Baltimore MD 21208 Oral Surgeon Baltimore<br />
Gordon James Drs. Branoff & Kress PA 3635 Old Court Rd., Suite 505 Baltimore MD 21208 Orthodontist Baltimore<br />
Greenberg Ned 000000011212 Ned S Greenberg DDS PA 2100 Eastern Boulevard Baltimore MD 21220 General Provider Baltimore<br />
Livingston Herbert Ned S Greenberg DDS PA Specialist 2100 Eastern Boulevard Baltimore MD 21220 Periodontist Baltimore<br />
Zia Amir 000000002690 Lansdowne Family <strong>Dental</strong> 2717 Hammonds Ferry Rd. Baltimore MD 21227 General Provider Baltimore<br />
Ramamurthy S 000000000271 S.V. Ramamurthy, D.D.S. 8713 Harford Rd. Baltimore MD 21234 General Provider Baltimore<br />
Romeo Frank Frank J. Romeo, D.D.S. 7544 Belair Road Baltimore MD 21236 Oral Surgeon Baltimore<br />
Fechter Maury 000000000291 Maury J. Fechter, D.D.S. 8817 Belair Road, Suite 105 Baltimore MD 21236 General Provider Baltimore<br />
Abrahams Heather Orthodontic Associates 7544 Belair Road, 2Nd Floor Baltimore MD 21236 Orthodontist Baltimore<br />
Miller Jeffrey Orthodontic Associates 7544 Belair Road, 2Nd Floor Baltimore MD 21236 Orthodontist Baltimore<br />
Williams David Orthodontic Associates 7544 Belair Road, 2Nd Floor Baltimore MD 21236 Orthodontist Baltimore<br />
Kodeck Robert 000000000356 Robert Kodeck, D.D.S. 7850 Rossville Blvd. Baltimore MD 21236 General Provider Baltimore<br />
Angamuthu Vijayalakshmi 000000017177 Convenient <strong>Dental</strong> 1726 North Rolling Road Baltimore MD 21244 General Provider Baltimore<br />
Yuille Bruce 000000000409 Bruce E.Yuille, D.D.S. 700 Geipe Road, Suite 270 Catonsville MD 21228 General Provider Baltimore<br />
Clark Maxine Maryland Orthodontic Specialists 2 E Rolling Crossroads Catonsville MD 21228 Orthodontist Baltimore<br />
Abrahams Heather Orthodontic Associates 606 Frederick Road, 2nd Floor Catonsville MD 21228 Orthodontist Baltimore<br />
Miller Jeffrey Orthodontic Associates 606 Frederick Road, 2nd Floor Catonsville MD 21228 Orthodontist Baltimore<br />
Williams David Orthodontic Associates 606 Frederick Road, 2nd Floor Catonsville MD 21228 Orthodontist Baltimore<br />
Dahne Marlene 000000000396 The <strong>Dental</strong> Care Center 4 East Rolling Crossroads, Suite 104 Catonsville MD 21228 General Provider Baltimore<br />
Tzomides Thomas 000000051041 Thomas G Tzomides DDS LLC 30 Middle River Rd Middle River MD 21220 General Provider Baltimore<br />
Berman Barry Barry R. Berman , D.D.S. 110 Painters Mill Road Owings Mills MD 21117 Oral Surgeon Baltimore<br />
Moore Brian 000000051086 Brian C Moore DMD PC 10085 Red Run Blvd, Suite 407 Owings Mills MD 21117 General Provider Baltimore<br />
* Miller Cynthia 000000000562 Cynthia F. Miller, D.D.S. 6 Park Center Court, Suite 107 Owings Mills MD 21117 General Provider Baltimore<br />
Millman Jules 000000000302 Jules Millman, D.D.S. 10353 Reisterstown Rd. Owings Mills MD 21117 General Provider Baltimore<br />
Abrahams Heather Orthodontic Associates 20 Crossroads Drive Ste. 116 Owings Mills MD 21117 Orthodontist Baltimore<br />
* Indicates dentist that is accepting current patients only.<br />
All <strong>Select</strong> <strong>Plan</strong> <strong>Dentist</strong>s Page 3<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 <strong>Dentist</strong>. Fac ID is used to indicate which facility a member chooses.
SELECT PLAN 1 DENTIST DIRECTORY<br />
<strong>Dentist</strong>s listed are under contract as of 9/1/12<br />
Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />
Miller Jeffrey Orthodontic Associates 20 Crossroads Drive Ste. 116 Owings Mills MD 21117 Orthodontist Baltimore<br />
Williams David Orthodontic Associates 20 Crossroads Drive Ste. 116 Owings Mills MD 21117 Orthodontist Baltimore<br />
Belt Ogden 000000000767 Ogden M. Belt, D.D.S. The Commerce Center, 1777 Reisterstown Rd., #220 Pikesville MD 21208 General Provider Baltimore<br />
Snell, II Franklin 000000037724 Esquire Family <strong>Dental</strong> Care, LLC 3673 Offutt Rd Randallstown MD 21133 General Provider Baltimore<br />
Freundlich Howard 000000009719 Pleet And Freundlich DDS Pa 5310 Old Court Road, 202 Randallstown MD 21133 General Provider Baltimore<br />
Markow Steven 000000009719 Pleet And Freundlich DDS Pa 5310 Old Court Road, 202 Randallstown MD 21133 General Provider Baltimore<br />
Garfinkel Allan Allan V. Garfinkel, D.D.S. 100 Owings Court #16 Reisterstown MD 21136 Oral Surgeon Baltimore<br />
Gordon James Drs. Branoff & Kress PA 100 Owings Court, Suite 16 Reisterstown MD 21136 Orthodontist Baltimore<br />
Fields David David A Fields Jr DDS Pa 2300 York Road, Suite 204 Timonium MD 21093 Orthodontist Baltimore<br />
McCausland, III Charles 000000051098 Charles P McCausland III DDS 312 W Chesapeake Ave Towson MD 21204 General Provider Baltimore<br />
Rosengarden Ivan 000000000529 Joppa Partners 219 W. Joppa Rd. Towson MD 21204 General Provider Baltimore<br />
Sehdev Inderjit 000000000529 Joppa Partners 219 W. Joppa Rd. Towson MD 21204 General Provider Baltimore<br />
Lucas Peter Brenda K. Richardson, D.D.S. 515 E. Joppa Rd., Ste. 106 Towson MD 21286 Endodontist Baltimore<br />
Richardson Brenda Brenda K. Richardson, D.D.S. 515 E. Joppa Rd., Ste. 106 Towson MD 21286 Endodontist Baltimore<br />
* Mastella Stephen 000000000294 Stephen B. Mastella, D.M.D. & Assoc, PA 1030 N Charles St, Suite 302 Baltimore MD 21201 General Provider Baltimore City<br />
* Narun Martin Stephen B. Mastella, D.M.D. & Assoc, PA 1030 N Charles St, Suite 302 Baltimore MD 21201 Periodontist Baltimore City<br />
* Stockmann-Morte Karin Stephen B. Mastella, D.M.D. & Assoc, PA 1030 N Charles St, Suite 302 Baltimore MD 21201 Periodontist Baltimore City<br />
Fechter Maury 000000000292 Maury J. Fechter, D.D.S. 700 North Linwood Ave. Baltimore MD 21205 General Provider Baltimore City<br />
Kromah Margaret 000000037648 Margaret Kromah, D.D.S. 4403 Moravia Rd., Suite 2 Baltimore MD 21206 General Provider Baltimore City<br />
Fechter Maury 000000037616 Maury J. Fechter, D.D.S. 6305 Bel Air Rd. Baltimore MD 21206 General Provider Baltimore City<br />
Colvin Ernest 000000068517 Ernest J Colvin & Associates 5808 York Rd, Suite A Baltimore MD 21212 General Provider Baltimore City<br />
Goodman Robert 000000025390 Robert A Goodman DDS 6301 North Charles Street, Suite 3 Baltimore MD 21212 General Provider Baltimore City<br />
Hickey Stephen 000000069564 Stephen J Hickey DMD 5010 Harford Rd Baltimore MD 21214 General Provider Baltimore City<br />
Colvin Ernest 000000068516 Ernest J Colvin & Associates 4413 1/2 Park Heights Ave Baltimore MD 21215 General Provider Baltimore City<br />
Butler Stewart 000000037575 Park West Health Systems 3319 W. Belvedere Ave. Baltimore MD 21215 General Provider Baltimore City<br />
Dunstan Hyacinth 000000037575 Park West Health Systems 3319 W. Belvedere Ave. Baltimore MD 21215 General Provider Baltimore City<br />
Einbinder Elliot 000000037575 Park West Health Systems 3319 W. Belvedere Ave. Baltimore MD 21215 General Provider Baltimore City<br />
Langermann Rena 000000001207 Rena K. Langermann, DDS 6606 Cross Country Blvd. Baltimore MD 21215 General Provider Baltimore City<br />
Desbordes Fabian 000000018764 Fabian F Desbordes DDS 2300 Garrison Boulevard, Suite 250 Baltimore MD 21216 General Provider Baltimore City<br />
Bell Lawrence 000000001382 Bell & Associates 3326 Auchentoroly Terrace Baltimore MD 21217 General Provider Baltimore City<br />
Dyson, Jr. Joseph 000000000164 Joseph L. Dyson, Jr., D.D.S. 1721 Pennsylvania Ave. Baltimore MD 21217 General Provider Baltimore City<br />
Glascoe Alison David A Camorali DDS Specialists 1010 S North Pointe Blvd Baltimore MD 21224 Periodontist Baltimore City<br />
Mitcherling John Mitcherling Mitcherling & Johnson PA 1107 N Point Blvd, Suite 204 Baltimore MD 21224 Oral Surgeon Baltimore City<br />
Mitcherling William Mitcherling Mitcherling & Johnson PA 1107 N Point Blvd, Suite 204 Baltimore MD 21224 Oral Surgeon Baltimore City<br />
Reyes Vivencio 000000000368 Vivencio R. Reyes, D.D.S., P.A. 402 South Highland Ave. Baltimore MD 21224 General Provider Baltimore City<br />
Krishnan Radha Calvert Orthodontics 294 Merrimac Court Prince Frederick MD 20678 Orthodontist Calvert<br />
Niemann Ralph Ralph W Niemann DDS 272 Merrimac Ct Prince Frederick MD 20678 Endodontist Calvert<br />
Dowling Thomas Thomas F. Dowling, DDS 310 Merrimac Court Prince Frederick MD 20678 Orthodontist Calvert<br />
Gordon James Drs. Branoff & Kress PA 1425 Liberty Rd., #16 Eldersburg MD 21784 Orthodontist Carroll<br />
Addicks Earl 000000068507 Earl M Addicks DDS PC 2025 Suffolk Rd, Suite 12 Finksburg MD 21048 General Provider Carroll<br />
Fields David David A Fields DDS 511 Jermor Ln, Suite 101 Westminster MD 21157 Orthodontist Carroll<br />
Grillon George George L. Grillon, D.M.D. 250 Englar Road #4 Westminster MD 21157 Oral Surgeon Carroll<br />
Gham Deepali 000000070916 Delmarva Center for <strong>Dental</strong> Excellence 230 S Bridge St, Suite A Elkton MD 21921 General Provider Cecil<br />
Abbasian Vargha 000000002757 Vargha Abbasian, D.D.S., P.C. 1653 Elkton Rd. Elkton MD 21921 General Provider Cecil<br />
* Pasqualini Charles 000000000184 C.V. Pasqualini, Jr., D.M.D. 111 Howard Street Elkton MD 21922 General Provider Cecil<br />
* Hewitt Godfrey 000000000410 Metro <strong>Dental</strong> Center 6620 Crain Highway #204 La Plata MD 20646 General Provider Charles<br />
* John Orville 000000000410 Metro <strong>Dental</strong> Center 6620 Crain Highway #204 La Plata MD 20646 General Provider Charles<br />
* Morgan-Belcher Althea 000000000410 Metro <strong>Dental</strong> Center 6620 Crain Highway #204 La Plata MD 20646 General Provider Charles<br />
King Michael King Oral Surgery Group PC 11885 Holly Lane, Suite 2 Waldorf MD 20601 Oral Surgeon Charles<br />
Hector Ricardo 000000072092 Aegis <strong>Dental</strong> Group LLC 363 Smallwood Dr Waldorf MD 20602 General Provider Charles<br />
Doumit Antoine Antoine Doumit DMD CAGS PC 603 Post Office Rd, Suite 109 Waldorf MD 20602 Orthodontist Charles<br />
Fitchett Glander 000000000434 Post Office Lake <strong>Dental</strong> Assoc. 603 Post Office Road, Suite 208 Waldorf MD 20602 General Provider Charles<br />
Hood, III James 000000000434 Post Office Lake <strong>Dental</strong> Assoc. 603 Post Office Road, Suite 208 Waldorf MD 20602 General Provider Charles<br />
Wiltshire Cathy Post Office Lake <strong>Dental</strong> Assoc. 603 Post Office Road, Suite 208 Waldorf MD 20602 Orthodontist Charles<br />
Maloney Joseph 000000002324 Tuan D Pham DMD & Joseph A Maloney DDS LLC 3450 Old Washington Road, Suite 204 Waldorf MD 20602 General Provider Charles<br />
Pham Tuan 000000002324 Tuan D Pham DMD & Joseph A Maloney DDS LLC 3450 Old Washington Road, Suite 204 Waldorf MD 20602 General Provider Charles<br />
Niemann Ralph Ralph W Niemann DDS 3050 Crain Hwy, Suite 303 Waldorf MD 20604 Endodontist Charles<br />
Romanow Gregory Goldblatt, Sweeney & Wise, D.D.S., MS 504 West Patrick Street, Suite D Frederick MD 21701 Oral Surgeon Frederick<br />
Sweeney Albert Goldblatt, Sweeney & Wise, D.D.S., MS 504 West Patrick Street, Suite D Frederick MD 21701 Oral Surgeon Frederick<br />
Wise John Goldblatt, Sweeney & Wise, D.D.S., MS 504 West Patrick Street, Suite D Frederick MD 21701 Oral Surgeon Frederick<br />
Pierce Kurt Kurt A. Pierce, D.D.S., M.S. 604 Solarex Ct., #209 Frederick MD 21701 Orthodontist Frederick<br />
Leon Lili Behnaz Yalda, D.D.S. 77 Thomas Johnson Dr., #D Frederick MD 21702 Periodontist Frederick<br />
Yalda Behnaz Behnaz Yalda, D.D.S. 77 Thomas Johnson Dr., #D Frederick MD 21702 Periodontist Frederick<br />
Alayssami Mazin 000000000193 Bright Now <strong>Dental</strong> 68 Thomas Johnson Dr., Suite B Frederick MD 21702 General Provider Frederick<br />
Byrd Richard Bright Now <strong>Dental</strong> 68 Thomas Johnson Dr., Suite B Frederick MD 21702 Orthodontist Frederick<br />
Hwang Gyu 000000000193 Bright Now <strong>Dental</strong> 68 Thomas Johnson Dr., Suite B Frederick MD 21702 General Provider Frederick<br />
* Indicates dentist that is accepting current patients only.<br />
All <strong>Select</strong> <strong>Plan</strong> <strong>Dentist</strong>s Page 4<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 <strong>Dentist</strong>. Fac ID is used to indicate which facility a member chooses.
SELECT PLAN 1 DENTIST DIRECTORY<br />
<strong>Dentist</strong>s listed are under contract as of 9/1/12<br />
Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />
Mazin Mark 000000000193 Bright Now <strong>Dental</strong> 68 Thomas Johnson Dr., Suite B Frederick MD 21702 General Provider Frederick<br />
Park Sang Hoon Bright Now <strong>Dental</strong> 68 Thomas Johnson Dr., Suite B Frederick MD 21702 Periodontist Frederick<br />
Pinetti John 000000000193 Bright Now <strong>Dental</strong> 68 Thomas Johnson Dr., Suite B Frederick MD 21702 General Provider Frederick<br />
Saini Viney Clarksburg Orthodontics 182 Thomas Johnson Dr, Suite 104 Frederick MD 21702 Orthodontist Frederick<br />
Muko Deep 000000069530 Deep Muko DDS PA 198 Thomas Johnson Dr, Suite 18 Frederick MD 21702 General Provider Frederick<br />
Benitez Karen Dr. Sivakumar Pediatric <strong>Dental</strong> Center, LLC 57 A Thomas Johnson Drive, Suite 101 Frederick MD 21702 Pedodontist Frederick<br />
Kim Joonghyuk Dr. Sivakumar Pediatric <strong>Dental</strong> Center, LLC 57 A Thomas Johnson Drive, Suite 101 Frederick MD 21702 Pedodontist Frederick<br />
Lan Steve Dr. Sivakumar Pediatric <strong>Dental</strong> Center, LLC 57 A Thomas Johnson Drive, Suite 101 Frederick MD 21702 Pedodontist Frederick<br />
Sivakumar Savithri Dr. Sivakumar Pediatric <strong>Dental</strong> Center, LLC 57 A Thomas Johnson Drive, Suite 101 Frederick MD 21702 Pedodontist Frederick<br />
Sivakumar Thiruvanamalai Dr. Sivakumar Pediatric <strong>Dental</strong> Center, LLC 57 A Thomas Johnson Drive, Suite 101 Frederick MD 21702 Pedodontist Frederick<br />
Best Ronald Mid Maryland Oral And Maxillofacial Surgery 68 Thomas Johnson Drive, Suite A Frederick MD 21702 Oral Surgeon Frederick<br />
Kelley Richard Mid Maryland Oral And Maxillofacial Surgery 68 Thomas Johnson Drive, Suite A Frederick MD 21702 Oral Surgeon Frederick<br />
Tan Peter Mid Maryland Oral And Maxillofacial Surgery 68 Thomas Johnson Drive, Suite A Frederick MD 21702 Oral Surgeon Frederick<br />
Zwack William Mid Maryland Oral And Maxillofacial Surgery 68 Thomas Johnson Drive, Suite A Frederick MD 21702 Oral Surgeon Frederick<br />
Patel Suketu Alayssami <strong>Dental</strong>, P.C. Specialists 5726-B Buckeystown Pke Frederick MD 21704 Oral Surgeon Frederick<br />
Alayssami Mazin 000000037595 Bright Now <strong>Dental</strong> 5726 B. Buckeystown Pike Frederick MD 21704 General Provider Frederick<br />
Byrd Richard Bright Now <strong>Dental</strong> 5726 B. Buckeystown Pike Frederick MD 21704 Orthodontist Frederick<br />
Thomasian Helen 000000037595 Bright Now <strong>Dental</strong> 5726 B. Buckeystown Pike Frederick MD 21704 General Provider Frederick<br />
Abousy Dawn 000000050727 Alpha <strong>Dental</strong> Excellence 122 N Philadelphia Blvd Aberdeen MD 21001 General Provider Harford<br />
Crocken Kerry 000000050727 Alpha <strong>Dental</strong> Excellence 122 N Philadelphia Blvd Aberdeen MD 21001 General Provider Harford<br />
Mahajan Priti 000000050727 Alpha <strong>Dental</strong> Excellence 122 N Philadelphia Blvd Aberdeen MD 21001 General Provider Harford<br />
Patel Arpan 000000050727 Alpha <strong>Dental</strong> Excellence 122 N Philadelphia Blvd Aberdeen MD 21001 General Provider Harford<br />
Kubiczek Iwona 000000002857 Iwona Kubiczek, D.D.S., P.C. 2021-B Emmorton Rd., Suite 216 Bel Air MD 21015 General Provider Harford<br />
Abrahams Heather Orthodontic Associates 2225 Old Emmorton Road, Suite 200 Bel Air MD 21015 Orthodontist Harford<br />
Miller Jeffrey Orthodontic Associates 2225 Old Emmorton Road, Suite 200 Bel Air MD 21015 Orthodontist Harford<br />
Williams David Orthodontic Associates 2225 Old Emmorton Road, Suite 200 Bel Air MD 21015 Orthodontist Harford<br />
Mazer Millard Thomas G Tzomides DDS LLC Specialists 2404 Pleasantville Rd Fallston MD 21047 Periodontist Harford<br />
Davanlou Azita 000000002723 Chartwell <strong>Dental</strong> Group 8180 Lark Brown Rd., Suite 202 Elkridge MD 21075 General Provider Howard<br />
* Skillman Robert 000000019200 Robert E Skillman, D.D.S., PA 5921 Old Washington Road Elkridge MD 21075 General Provider Howard<br />
Ajmal Nighat 000000022440 Ajmal <strong>Dental</strong> Care 10306 B Baltimore National Pik Ellicott City MD 21042 General Provider Howard<br />
Ajmal Riffat 000000022440 Ajmal <strong>Dental</strong> Care 10306 B Baltimore National Pik Ellicott City MD 21042 General Provider Howard<br />
Sedighian Ali 000000037537 Ali R. Sedighian, D.D.S., P.A. 9005 Chevrolet Dr., Suite 1 Ellicott City MD 21042 General Provider Howard<br />
Kim Philip 000000070463 Family <strong>Dentist</strong>ry 9005 Chevrolet Dr, Suite 3 Ellicott City MD 21042 General Provider Howard<br />
Kim JoongSeo JoongSeo Kim DDS PC 10176 Baltimore National Pike, Suite 206 Ellicott City MD 21042 Prosthodontist Howard<br />
Clark Maxine Maryland Orthodontic Specialists 5094 Dorsey Hall Dr, Suite 204 Ellicott City MD 21042 Orthodontist Howard<br />
Abrahams Heather Orthodontic Associates 537-F Balt-Annapolis Blvd, P.O. Box 362 Ellicott City MD 21042 Orthodontist Howard<br />
Miller Jeffrey Orthodontic Associates 537-F Balt-Annapolis Blvd, P.O. Box 362 Ellicott City MD 21042 Orthodontist Howard<br />
Williams David Orthodontic Associates 537-F Balt-Annapolis Blvd, P.O. Box 362 Ellicott City MD 21042 Orthodontist Howard<br />
Winnard Robert Robert G. Winnard, D.M.D. 10030 Baltimore National Pike Ellicott City MD 21042 Orthodontist Howard<br />
Kang Sinha 000000069942 Sinha Kang DMD 5034 Dorsey Hall Dr, Suite 203 Ellicott City MD 21042 General Provider Howard<br />
Esi Ejiro Esi Orthodontics 8170 Maple Lawn Blvd Fulton MD 20759 Orthodontist Howard<br />
Blucher Craig 000000069952 Dr Bluchers Family <strong>Dentist</strong>ry 10741 Birmingham Way Woodstock MD 21163 General Provider Howard<br />
Milobsky Stanley Stanley A Milobsky DDS 13975 Connecticut Ave, Suite 318 Aspen Hill MD 20906 Endodontist Montgomery<br />
Heller Alan Alan R. Heller, D.D.S., M.S. 4405 East West Highway, #106 Bethesda MD 20814 Orthodontist Montgomery<br />
Ross David David S. Ross, D.D.S., PC 4949 Battery Lane Bethesda MD 20814 Oral Surgeon Montgomery<br />
Okun Martin Orthodontic Center of Maryland/Virginia 7201 Wisconsin Ave., Suite 370 Bethesda MD 20814 Orthodontist Montgomery<br />
DeMizio Peter 000000050850 Peter S DeMizio DDS <strong>Inc</strong> 4400 East West Hwy, Suite D Bethesda MD 20814 General Provider Montgomery<br />
DeMizio Peter Peter S DeMizio DDS <strong>Inc</strong> 4400 East West Hwy, Suite D Bethesda MD 20814 Oral Surgeon Montgomery<br />
* Cole Reginald 000000000460 Reginald W Cole, DDS 4400 East-West Hwy Suite F Bethesda MD 20814 General Provider Montgomery<br />
Sethi Shalini Roanne Wiczer DMD 8311 Wisconsin Ave, Suite B8 Bethesda MD 20814 Periodontist Montgomery<br />
Wiczer Roanne 000000001405 Roanne Wiczer DMD 8311 Wisconsin Ave, Suite B8 Bethesda MD 20814 General Provider Montgomery<br />
Shroff Amisha 000000002367 Amisha N. Shroff, D.D.S., P.C. 10320 Westlake Drive, Suite 109 Bethesda MD 20817 General Provider Montgomery<br />
Grillon George George L. Grillon, D.M.D., P.C. 10215 Fernwood Rd, Ste. 510 Bethesda MD 20817 Oral Surgeon Montgomery<br />
Sheik Mon 000000037698 Mon F. Sheik, DMD 15234 Spencerville Ct, 101 Burtonsville MD 20866 General Provider Montgomery<br />
Saini Viney Viney P. Saini, D.D.S., M.S., LLC 23220 Brewers Tavern Way Clarksburg MD 20871 Orthodontist Montgomery<br />
Heller Alan Alan R Heller DDS 12116 Darnestown Road, Suite L 1 Darnestown MD 20878 Orthodontist Montgomery<br />
Malhmood Arnold 000000004589 Arnold I Malhmood DDS 474 North Frederick Avenue Gaithersburg MD 20877 General Provider Montgomery<br />
Chung Jay 000000050592 Chestnut Street Cosmetic <strong>Dentist</strong>ry 101 Chestnut Street, Suite 130 Gaithersburg MD 20877 General Provider Montgomery<br />
Dubin Gerry 000000002432 Gerry Dubin, DMD, P.C. 9069 Shady Grove Ct. Gaithersburg MD 20877 General Provider Montgomery<br />
Elkhateeb Mohammad 000000002854 TLC Modern <strong>Dentist</strong>ry 18220 Contour Rd. Gaithersburg MD 20877 General Provider Montgomery<br />
Le Chinh 000000002854 TLC Modern <strong>Dentist</strong>ry 18220 Contour Rd. Gaithersburg MD 20877 General Provider Montgomery<br />
Nguyen Helen 000000002854 TLC Modern <strong>Dentist</strong>ry 18220 Contour Rd. Gaithersburg MD 20877 General Provider Montgomery<br />
Nguyen Thy 000000002854 TLC Modern <strong>Dentist</strong>ry 18220 Contour Rd. Gaithersburg MD 20877 General Provider Montgomery<br />
Tran Quang 000000002854 TLC Modern <strong>Dentist</strong>ry 18220 Contour Rd. Gaithersburg MD 20877 General Provider Montgomery<br />
Lavine David Drs. Lavine and Decker 12113 Darnestown Rd Gaithersburg MD 20878 Orthodontist Montgomery<br />
Hassani Eftekhar 000000033884 Angamuthu & Associates DDS PA 4 Professional Dr., Suite 121 Gaithersburg MD 20879 General Provider Montgomery<br />
* Indicates dentist that is accepting current patients only.<br />
All <strong>Select</strong> <strong>Plan</strong> <strong>Dentist</strong>s Page 5<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 <strong>Dentist</strong>. Fac ID is used to indicate which facility a member chooses.
SELECT PLAN 1 DENTIST DIRECTORY<br />
<strong>Dentist</strong>s listed are under contract as of 9/1/12<br />
Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />
Jesson Vijayalakshmi 000000033884 Angamuthu & Associates DDS PA 4 Professional Dr., Suite 121 Gaithersburg MD 20879 General Provider Montgomery<br />
Tsintolas Chris Chris E. Tsintolas, D.D.S., M.S. 903 Russell Ave., #101 Gaithersburg MD 20879 Orthodontist Montgomery<br />
Romanow Gregory Goldblatt, Sweeney & Wise, D.D.S., MS 985 Russel Ave. Gaithersburg MD 20879 Oral Surgeon Montgomery<br />
Sweeney Albert Goldblatt, Sweeney & Wise, D.D.S., MS 985 Russel Ave. Gaithersburg MD 20879 Oral Surgeon Montgomery<br />
Wise John Goldblatt, Sweeney & Wise, D.D.S., MS 985 Russel Ave. Gaithersburg MD 20879 Oral Surgeon Montgomery<br />
Winnick Mark Mark B WinnickDDS PA 803 Russell Ave, #3A Gaithersburg MD 20879 Periodontist Montgomery<br />
Ghahreman Habib 000000000463 The <strong>Dental</strong> Suite 18218 Flower Hill Way Gaithersburg MD 20879 General Provider Montgomery<br />
Mirdamadi Behzad 000000000463 The <strong>Dental</strong> Suite 18218 Flower Hill Way Gaithersburg MD 20879 General Provider Montgomery<br />
Venigalla Lakshmi 000000004687 Family <strong>Dental</strong> Care 19729 Executive Park circle Germantown MD 20874 General Provider Montgomery<br />
Pierce Kurt Kurt A. Pierce, D.D.S., M.S. North Lake Medical Park, 19507 Doctors Drive Germantown MD 20874 Orthodontist Montgomery<br />
Tomona Natalia Natalia Tomona, D.D.S., PC 19735 Germantown Rd., Suite 140 Germantown MD 20874 Orthodontist Montgomery<br />
Liashek Peter Peter Liashek, Jr., D.D.S. 19717 Executive Pk. Circle Germantown MD 20874 Oral Surgeon Montgomery<br />
DeMizio Peter 000000037733 Peter S. DeMizio, DDS, <strong>Inc</strong>. 22 Executive Park Ct Germantown MD 20874 General Provider Montgomery<br />
DeMizio Peter Peter S. DeMizio, DDS, <strong>Inc</strong>. 22 Executive Park Ct Germantown MD 20874 Oral Surgeon Montgomery<br />
Nguyen Toan 000000050893 Smile Design <strong>Dental</strong> 19735 Germantown RD, Suite 170 Germantown MD 20874 General Provider Montgomery<br />
Barnett Robert 000000014880 Robert Barnett DDS 3720 Farragut Avenue, Suite 101 Kensington MD 20895 General Provider Montgomery<br />
Davis Gail Davis Endodontics 11908 Darnestown Rd., Suite F North Potomac MD 20878 Endodontist Montgomery<br />
Assatourian Karineh 000000050918 Premier <strong>Dental</strong> Clinic 17904 Georgia Ave, Suite 110 Olney MD 20832 General Provider Montgomery<br />
Dowling Thomas Thomas F. Dowling, D.D.S. 3403 Olandwood Court, Suite 201 Olney MD 20832 Orthodontist Montgomery<br />
Masood Arif 000000037547 Arif Masood, MSD, PC 9850 Key West Ave, Ste 302 Rockville MD 20850 General Provider Montgomery<br />
Cohen Lisa Maryland Oral Surgery Associates 14955 Shady Grove Rd., Suite 330 Rockville MD 20850 Oral Surgeon Montgomery<br />
Griffith Miari-Ann Maryland Oral Surgery Associates 14955 Shady Grove Rd., Suite 330 Rockville MD 20850 Oral Surgeon Montgomery<br />
Kashyap Anil Maryland Oral Surgery Associates 14955 Shady Grove Rd., Suite 330 Rockville MD 20850 Oral Surgeon Montgomery<br />
Patel Chirag Maryland Oral Surgery Associates 14955 Shady Grove Rd., Suite 330 Rockville MD 20850 Oral Surgeon Montgomery<br />
Robinson Brian Maryland Oral Surgery Associates 14955 Shady Grove Rd., Suite 330 Rockville MD 20850 Oral Surgeon Montgomery<br />
Stark Mitchell Maryland Oral Surgery Associates 14955 Shady Grove Rd., Suite 330 Rockville MD 20850 Oral Surgeon Montgomery<br />
Trinh Huy Maryland Oral Surgery Associates 14955 Shady Grove Rd., Suite 330 Rockville MD 20850 Oral Surgeon Montgomery<br />
* Kodsi Nadim 000000037655 North Potomac Smiles LLC 15200 Shady Grove Road, Suite 408 Rockville MD 20850 General Provider Montgomery<br />
Chang Richard Richard Chang, D.M.D. 14955 Shady Grove Rd, 310 Rockville MD 20850 Orthodontist Montgomery<br />
Atam Asugman 000000033849 AA <strong>Dental</strong> Clinic 751 Rockville Pike, Suite 10A Rockville MD 20852 General Provider Montgomery<br />
* Parikh Chetan 000000002745 Chetan H. Parikh, D.M.D., PA 5808 Hubbard Dr. Rockville MD 20852 General Provider Montgomery<br />
Ha Derrick 000000050814 Happy <strong>Dental</strong> 4701 Randolph Road, Suite 210 Rockville MD 20852 General Provider Montgomery<br />
*Kim Hyosik 000000001041 Hysosik Kim, D.D.S. 785-A Rockville Pike Rockville MD 20852 General Provider Montgomery<br />
Kishter Steven Maryland Oral Surgery Associates of Bethesda LLC 11404 Old Georgetown Rd, Suite 104 Rockville MD 20852 Oral Surgeon Montgomery<br />
Patel Chirag Maryland Oral Surgery Associates of Bethesda LLC 11404 Old Georgetown Rd, Suite 104 Rockville MD 20852 Oral Surgeon Montgomery<br />
Chung Jay 000000000447 Montrose <strong>Dental</strong> Office 6232 Montrose Road Rockville MD 20852 General Provider Montgomery<br />
Singer Richard Richard P. Singer, D.D.S. 11300 Rockville Pike, #1210 Rockville MD 20852 Periodontist Montgomery<br />
Tofigh Hamid 000000037731 Rockville Family <strong>Dental</strong> Group 5806 Hubbard Dr Rockville MD 20852 General Provider Montgomery<br />
Esfandiari Sheila Tenley Orthodontics - Sheila Esfandiari, DDS, P.C. 50 West Edmonston Drive, #205 Rockville MD 20852 Orthodontist Montgomery<br />
Atashbar Hedyeh 000000001753 Hedyeh Atashbar, D.D.S. 11213 Lockwood Drive Silver Spring MD 20901 General Provider Montgomery<br />
Romanow Gregory Goldblatt,Sweeney & Wise, D.D.S., P.A. 10313 Georgia Ave # 102 Silver Spring MD 20902 Oral Surgeon Montgomery<br />
Sweeney Albert Goldblatt,Sweeney & Wise, D.D.S., P.A. 10313 Georgia Ave # 102 Silver Spring MD 20902 Oral Surgeon Montgomery<br />
Wise John Goldblatt,Sweeney & Wise, D.D.S., P.A. 10313 Georgia Ave # 102 Silver Spring MD 20902 Oral Surgeon Montgomery<br />
Potluri Sumesh Silver Spring Endodontics 10301 Georgia Ave, Suite 202 Silver Spring MD 20902 Endodontist Montgomery<br />
Nuh Asma 000000051014 Asma Nuh DDS PA 1016 Merrimac Dr Silver Spring MD 20903 General Provider Montgomery<br />
De Marco Lisa Drs DeMarco & Tilkin PA 11120 New Hampshire Ave., Suite 402 Silver Spring MD 20904 Orthodontist Montgomery<br />
Tilkin Nancy Drs DeMarco & Tilkin PA 11120 New Hampshire Ave., Suite 402 Silver Spring MD 20904 Orthodontist Montgomery<br />
Okun Martin Martin L Okun DDS 2415 Musgrove Road, Suite 301 Silver Spring MD 20904 Orthodontist Montgomery<br />
Batrouni Ziad Maryland Oral Surgery Associates, PA 11120 New Hampshire Ave., Suite 501 Silver Spring MD 20904 Oral Surgeon Montgomery<br />
Cohen Lisa Maryland Oral Surgery Associates, PA 11120 New Hampshire Ave., Suite 501 Silver Spring MD 20904 Oral Surgeon Montgomery<br />
Griffith Miari-Ann Maryland Oral Surgery Associates, PA 11120 New Hampshire Ave., Suite 501 Silver Spring MD 20904 Oral Surgeon Montgomery<br />
Kashyap Anil Maryland Oral Surgery Associates, PA 11120 New Hampshire Ave., Suite 501 Silver Spring MD 20904 Oral Surgeon Montgomery<br />
Patel Chirag Maryland Oral Surgery Associates, PA 11120 New Hampshire Ave., Suite 501 Silver Spring MD 20904 Oral Surgeon Montgomery<br />
Robinson Brian Maryland Oral Surgery Associates, PA 11120 New Hampshire Ave., Suite 501 Silver Spring MD 20904 Oral Surgeon Montgomery<br />
Stark Mitchell Maryland Oral Surgery Associates, PA 11120 New Hampshire Ave., Suite 501 Silver Spring MD 20904 Oral Surgeon Montgomery<br />
Trinh Huy Maryland Oral Surgery Associates, PA 11120 New Hampshire Ave., Suite 501 Silver Spring MD 20904 Oral Surgeon Montgomery<br />
Haghighiyan Majid 000000051079 Silver Spring <strong>Dental</strong> Care LLC 13321 New Hampshire Ave, Suite 201 Silver Spring MD 20904 General Provider Montgomery<br />
Wiltshire Cathy Straighten Up Orthodontics 2415 Musgrove Rd, Suite 307 Silver Spring MD 20904 Orthodontist Montgomery<br />
Hector Ricardo 000000037792 Aegis <strong>Dental</strong> Group 14440 Layhill Rd Silver Spring MD 20906 General Provider Montgomery<br />
Bayley Neil Aspen Hill <strong>Dental</strong> Specialists 13975 Connecticut Ave, Suite 200-201 Silver Spring MD 20906 Oral Surgeon Montgomery<br />
Dompkowski Douglas Aspen Hill <strong>Dental</strong> Specialists 13975 Connecticut Ave, Suite 200-201 Silver Spring MD 20906 Periodontist Montgomery<br />
Mills Cordelia Aspen Hill <strong>Dental</strong> Specialists 13975 Connecticut Ave, Suite 200-201 Silver Spring MD 20906 Endodontist Montgomery<br />
Bhangra Kuljeet 000000008779 Aspen Hill General And Cosmetic <strong>Dentist</strong>ry 13975 Connecticut Avenue, Suite 200 Silver Spring MD 20906 General Provider Montgomery<br />
Goitom Liya 000000008779 Aspen Hill General And Cosmetic <strong>Dentist</strong>ry 13975 Connecticut Avenue, Suite 200 Silver Spring MD 20906 General Provider Montgomery<br />
Goorah Soorita 000000008779 Aspen Hill General And Cosmetic <strong>Dentist</strong>ry 13975 Connecticut Avenue, Suite 200 Silver Spring MD 20906 General Provider Montgomery<br />
Lee Richard Aspen Hill General And Cosmetic <strong>Dentist</strong>ry 13975 Connecticut Avenue, Suite 200 Silver Spring MD 20906 Orthodontist Montgomery<br />
* Indicates dentist that is accepting current patients only.<br />
All <strong>Select</strong> <strong>Plan</strong> <strong>Dentist</strong>s Page 6<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 <strong>Dentist</strong>. Fac ID is used to indicate which facility a member chooses.
SELECT PLAN 1 DENTIST DIRECTORY<br />
<strong>Dentist</strong>s listed are under contract as of 9/1/12<br />
Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />
McLaughlin Kaye 000000008779 Aspen Hill General And Cosmetic <strong>Dentist</strong>ry 13975 Connecticut Avenue, Suite 200 Silver Spring MD 20906 General Provider Montgomery<br />
Elkhateeb Mohammad 000000050327 TLC Modern <strong>Dentist</strong>ry LLC 13623 H-I Georgia Ave Silver Spring MD 20906 General Provider Montgomery<br />
Le Chinh 000000050327 TLC Modern <strong>Dentist</strong>ry LLC 13623 H-I Georgia Ave Silver Spring MD 20906 General Provider Montgomery<br />
Nguyen Helen 000000050327 TLC Modern <strong>Dentist</strong>ry LLC 13623 H-I Georgia Ave Silver Spring MD 20906 General Provider Montgomery<br />
Tran Quang 000000050327 TLC Modern <strong>Dentist</strong>ry LLC 13623 H-I Georgia Ave Silver Spring MD 20906 General Provider Montgomery<br />
* Achikeh Kingsley 000000000339 City Place <strong>Dental</strong> 8780 Georgia Ave Silver Spring MD 20910 General Provider Montgomery<br />
Moazami Negin 000000000844 Negin A. Moazami, D.D.S. 8630 Fenton Street, Suite 902 Silver Spring MD 20910 General Provider Montgomery<br />
Scott Stuart Scott Orthodontics 804 Pershing Dr, Suite 106 Silver Spring MD 20910 Orthodontist Montgomery<br />
Warner Oswald 000000000282 Warner Family <strong>Dental</strong> Center 7000 Carroll Ave. Takoma Park MD 20912 General Provider Montgomery<br />
Vaughan William 000000000692 William E. Vaughan, D.D.S. 7600 Maple Ave. Suite 6 Takoma Park MD 20912 General Provider Montgomery<br />
* Winkelman Peter 000000000192 Sterling <strong>Dental</strong> Centers 12114 Georgia Avenue Wheaton MD 20902 General Provider Montgomery<br />
Brutus Jean-Daniel 000000068505 Kemmerton Family <strong>Dentist</strong>ry 6000 Laurel-Bowie Rd, Suite 101 Bowie MD 20715 General Provider Prince Georges<br />
Menendez Leonardo Leo F Menendez DDS 3233 Superior Lane, Suite B23 Bowie MD 20715 Oral Surgeon Prince Georges<br />
Geballa Marc Marc G Geballa DDS 6911 Laurel-Bowie Rd., #313 Bowie MD 20715 Endodontist Prince Georges<br />
McKen Neville 000000000332 Neville McKen, D.D.S. 3060 Mitchellville Rd, Suite 213 Bowie MD 20715 General Provider Prince Georges<br />
Davis Tanzania 000000014419 Tanzania Davis DDS 3231 Superior Lane, Suite A 22 Bowie MD 20715 General Provider Prince Georges<br />
* Everett Dwayne Dwayne E Everett DDS 4000 Mitchellville Road, Suite A314 Bowie MD 20716 Oral Surgeon Prince Georges<br />
Vargas Eduardo Eduardo Vargas, D.D.S., M.S., PC 2905 Mitchellville Road, Suite 109 Bowie MD 20716 Prosthodontist Prince Georges<br />
Packman Harold Harold Packman, D.M.D., PA 14999 Health Cntr, Suite 110 Bowie MD 20716 Periodontist Prince Georges<br />
Ego Osuala Derek RCT Endodontics 3060 Mitchellville Rd, Suite 108 Bowie MD 20716 Endodontist Prince Georges<br />
Orgel Adam RCT Endodontics 3060 Mitchellville Rd, Suite 108 Bowie MD 20716 Endodontist Prince Georges<br />
Taylor Ronald RCT Endodontics 3060 Mitchellville Rd, Suite 108 Bowie MD 20716 Endodontist Prince Georges<br />
Labbe Stephen Stewart & Labbe, D.D.S., P.A. 4000 Mitcheville Road, Suite 316-318 Bowie MD 20716 Orthodontist Prince Georges<br />
Stewart Lamon Stewart & Labbe, D.D.S., P.A. 4000 Mitcheville Road, Suite 316-318 Bowie MD 20716 Orthodontist Prince Georges<br />
King Michael King Oral Surgery Group at Camp Springs 5801 Allentown Rd, Suite 408 Camp Springs MD 20746 Oral Surgeon Prince Georges<br />
Davis Vincent 000000000161 Gentle <strong>Dental</strong> Care / Dr. Vincent Davis 9146 Edgeworth Drive Capitol Heights MD 20743 General Provider Prince Georges<br />
McKen Neville 000000000333 Neville McKen, D.D.S. 9171 Central Ave., Suite L9 Capitol Heights MD 20743 General Provider Prince Georges<br />
Wilson Calvin 000000002862 Alpha <strong>Dental</strong> Care LLC 8975 Woodyard Rd Clinton MD 20735 General Provider Prince Georges<br />
Williams Alvin 000000037717 Alvin B Williams DDS 9135 Piscataway Rd, #105 Clinton MD 20735 General Provider Prince Georges<br />
Ego Osuala Derek Excelsis Root Canal Specialties 9113 Brandywine Rd Clinton MD 20735 Endodontist Prince Georges<br />
* Maloney Joseph 000000000735 Joseph A. Maloney, D.D.S. 9131 Piscataway Rd., Suite 739 Clinton MD 20735 General Provider Prince Georges<br />
Brager Stanley 000000037542 College Park <strong>Dental</strong> 7305 Baltimore Ave., #204 College Park MD 20740 General Provider Prince Georges<br />
Cherot Ani 000000037542 College Park <strong>Dental</strong> 7305 Baltimore Ave., #204 College Park MD 20740 General Provider Prince Georges<br />
Eghtesadi Ali College Park <strong>Dental</strong> 7305 Baltimore Ave., #204 College Park MD 20740 Endodontist Prince Georges<br />
Ghosh Gitanjali 000000037542 College Park <strong>Dental</strong> 7305 Baltimore Ave., #204 College Park MD 20740 General Provider Prince Georges<br />
Haghighiyan Majid 000000037542 College Park <strong>Dental</strong> 7305 Baltimore Ave., #204 College Park MD 20740 General Provider Prince Georges<br />
Hoang-Nguyen Jacquelyn 000000037542 College Park <strong>Dental</strong> 7305 Baltimore Ave., #204 College Park MD 20740 General Provider Prince Georges<br />
Hosain Rubeena 000000037542 College Park <strong>Dental</strong> 7305 Baltimore Ave., #204 College Park MD 20740 General Provider Prince Georges<br />
Kodsi Nadim 000000037542 College Park <strong>Dental</strong> 7305 Baltimore Ave., #204 College Park MD 20740 General Provider Prince Georges<br />
Liu Chiun-lin College Park <strong>Dental</strong> 7305 Baltimore Ave., #204 College Park MD 20740 Periodontist Prince Georges<br />
Su Esther 000000037542 College Park <strong>Dental</strong> 7305 Baltimore Ave., #204 College Park MD 20740 General Provider Prince Georges<br />
Tiwary Romila 000000037542 College Park <strong>Dental</strong> 7305 Baltimore Ave., #204 College Park MD 20740 General Provider Prince Georges<br />
Toufanian Sanam 000000037542 College Park <strong>Dental</strong> 7305 Baltimore Ave., #204 College Park MD 20740 General Provider Prince Georges<br />
Lane Daniel 000000000346 Daniel J. Lane, D.D.S. 7307 Baltimore Ave., Suite 113 College Park MD 20740 General Provider Prince Georges<br />
Cohen Lisa Maryland Oral Surgery Associates 6201 Greenbelt Rd., M-1 College Park MD 20740 Oral Surgeon Prince Georges<br />
Griffith Miari-Ann Maryland Oral Surgery Associates 6201 Greenbelt Rd., M-1 College Park MD 20740 Oral Surgeon Prince Georges<br />
Kashyap Anil Maryland Oral Surgery Associates 6201 Greenbelt Rd., M-1 College Park MD 20740 Oral Surgeon Prince Georges<br />
Nathan Glenn Maryland Oral Surgery Associates 6201 Greenbelt Rd., M-1 College Park MD 20740 Oral Surgeon Prince Georges<br />
Patel Chirag Maryland Oral Surgery Associates 6201 Greenbelt Rd., M-1 College Park MD 20740 Oral Surgeon Prince Georges<br />
Robinson Brian Maryland Oral Surgery Associates 6201 Greenbelt Rd., M-1 College Park MD 20740 Oral Surgeon Prince Georges<br />
Stark Mitchell Maryland Oral Surgery Associates 6201 Greenbelt Rd., M-1 College Park MD 20740 Oral Surgeon Prince Georges<br />
Trinh Huy Maryland Oral Surgery Associates 6201 Greenbelt Rd., M-1 College Park MD 20740 Oral Surgeon Prince Georges<br />
Larosiliere Patrick Essence <strong>Dental</strong> Care 5805 Silver Hill Rd, Suite G District Heights MD 20747 Orthodontist Prince Georges<br />
Obianwu Chilo 000000050328 All Smiles <strong>Dental</strong> Care 12803 Old Fort Rd, Suite 203 Fort Washington MD 20744 General Provider Prince Georges<br />
Palumbo Pat Drs. Palumbo and Palumbo LLC 10905 Fort Washington Rd, 214 Fort Washington MD 20744 Oral Surgeon Prince Georges<br />
* McKen Neville 000000000334 Neville McKen DDS 8602 Dover St. Fort Washington MD 20744 General Provider Prince Georges<br />
Hymes Pamela 000000000330 Pamela V. Hymes, D.D.S., PA 10905 Fort Washington Rd., Suite 203 Fort Washington MD 20744 General Provider Prince Georges<br />
Bryant Larry Larry W. Bryant, D.D.S., PA 12200 Annapolis Rd, Suite 236 Glenn Dale MD 20769 Oral Surgeon Prince Georges<br />
Fisher Christopher Christopher L. Fisher, D.D.S., P.A. 7525 Greenway Center Dr. #109 Greenbelt MD 20770 Oral Surgeon Prince Georges<br />
Wilson Adly 000000001187 Greenbelt <strong>Dental</strong> Care, P.C. 7525 Greenway Center Dr., Suite 201 Greenbelt MD 20770 General Provider Prince Georges<br />
Green Stephen Stephen I. Green, D.D.S., P.A. 7501 Greenway Ctr. Dr. # 260 Greenbelt MD 20770 Periodontist Prince Georges<br />
Labbe Stephen Stewart & Labbe, D.D.S., P.A. 7525 Greenway Ctr. Dr. Greenbelt MD 20770 Orthodontist Prince Georges<br />
Stewart Lamon Stewart & Labbe, D.D.S., P.A. 7525 Greenway Ctr. Dr. Greenbelt MD 20770 Orthodontist Prince Georges<br />
Moore Brian 000000051085 Brian C Moore DMD PC 3311 Toledo Terr, Suite C102 Hyattsville MD 20782 General Provider Prince Georges<br />
Bronstein Arden 000000000407 Friendship <strong>Dental</strong> 6525 Belcrest Rd., Suite 208 Hyattsville MD 20782 General Provider Prince Georges<br />
Davis Vincent 000000001331 Gentle <strong>Dental</strong> Care/ Dr. Vincent Davis 1836 Metzerott Rd., #118 Hyattsville MD 20783 General Provider Prince Georges<br />
* Indicates dentist that is accepting current patients only.<br />
All <strong>Select</strong> <strong>Plan</strong> <strong>Dentist</strong>s Page 7<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 <strong>Dentist</strong>. Fac ID is used to indicate which facility a member chooses.
SELECT PLAN 1 DENTIST DIRECTORY<br />
<strong>Dentist</strong>s listed are under contract as of 9/1/12<br />
Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />
Tajick Gita 000000002523 Tajicks <strong>Dental</strong> Clinic 7411 Riggs Rd., #108 Hyattsville MD 20783 General Provider Prince Georges<br />
* DeHaas Daniel 000000000960 Daniel De Haas, D.D.S. 7101 Annapolis Road Hyattsville MD 20784 General Provider Prince Georges<br />
Hall, III Bert 000000002370 Hall and Associates 7221 East Ridge Drive Hyattsville MD 20785 General Provider Prince Georges<br />
* Winkelman Peter 000000000191 Sterling <strong>Dental</strong> Centers 7503 A Annapolis Road Landover Hills MD 20784 General Provider Prince Georges<br />
Klapper Harry 000000000186 Harry J. Klapper, D.D.S. 1300 Mercantile Ln., Suite 100E Largo MD 20774 General Provider Prince Georges<br />
* Larosiliere Patrick Woodview <strong>Dental</strong> Specialists 1401 Mercantile Ln, Suite 102 Largo MD 20774 Orthodontist Prince Georges<br />
Sanusi Jemi 000000001270 Yardee <strong>Dental</strong>/ Dr. Jemi Sanusi 1400 Mercantile Ln. Ste.224 Largo MD 20774 General Provider Prince Georges<br />
Eghtesadi Ali Ali Eghtesadi DDS 8363 Cherry Ln Laurel MD 20707 Endodontist Prince Georges<br />
Batz Richard 000000001053 Drs. Batz and Weiner, Lake <strong>Dental</strong> 8363 Cherry Lane Laurel MD 20707 General Provider Prince Georges<br />
Brain Jeffrey Drs. Batz and Weiner, Lake <strong>Dental</strong> 8363 Cherry Lane Laurel MD 20707 Periodontist Prince Georges<br />
Danesh Fariba 000000001053 Drs. Batz and Weiner, Lake <strong>Dental</strong> 8363 Cherry Lane Laurel MD 20707 General Provider Prince Georges<br />
Dukes Jonathan 000000001053 Drs. Batz and Weiner, Lake <strong>Dental</strong> 8363 Cherry Lane Laurel MD 20707 General Provider Prince Georges<br />
Kavandi Shoreh 000000001053 Drs. Batz and Weiner, Lake <strong>Dental</strong> 8363 Cherry Lane Laurel MD 20707 General Provider Prince Georges<br />
Kim Sung 000000001053 Drs. Batz and Weiner, Lake <strong>Dental</strong> 8363 Cherry Lane Laurel MD 20707 General Provider Prince Georges<br />
Narendra Asha 000000001053 Drs. Batz and Weiner, Lake <strong>Dental</strong> 8363 Cherry Lane Laurel MD 20707 General Provider Prince Georges<br />
Nassiri Azadeh 000000001053 Drs. Batz and Weiner, Lake <strong>Dental</strong> 8363 Cherry Lane Laurel MD 20707 General Provider Prince Georges<br />
Phaeton Nathalie Drs. Batz and Weiner, Lake <strong>Dental</strong> 8363 Cherry Lane Laurel MD 20707 Pedodontist Prince Georges<br />
Seltzer Jared Drs. Batz and Weiner, Lake <strong>Dental</strong> 8363 Cherry Lane Laurel MD 20707 Endodontist Prince Georges<br />
Tan Chun 000000001053 Drs. Batz and Weiner, Lake <strong>Dental</strong> 8363 Cherry Lane Laurel MD 20707 General Provider Prince Georges<br />
Wai Wai Sint 000000001053 Drs. Batz and Weiner, Lake <strong>Dental</strong> 8363 Cherry Lane Laurel MD 20707 General Provider Prince Georges<br />
Weiner Mitchell 000000001053 Drs. Batz and Weiner, Lake <strong>Dental</strong> 8363 Cherry Lane Laurel MD 20707 General Provider Prince Georges<br />
Skane Timothy Harbour Endodontics PA 8363 Cherry Ln Laurel MD 20707 Endodontist Prince Georges<br />
Abel Jarred Jarred S Abel DDS 8363 Cherry Ln Laurel MD 20707 Oral Surgeon Prince Georges<br />
Rubin Jessica Jessica L Exelbert DDS 8363 Cherry Lane Laurel MD 20707 Pedodontist Prince Georges<br />
Kim John 000000001199 John N. Kim, D.D.S., P.A. 8301 Cherry Ln. Laurel MD 20707 General Provider Prince Georges<br />
Abrahams Heather Orthodontic Associates 8361 Cherrylane Laurel MD 20707 Orthodontist Prince Georges<br />
Miller Jeffrey Orthodontic Associates 8361 Cherrylane Laurel MD 20707 Orthodontist Prince Georges<br />
Williams David Orthodontic Associates 8361 Cherrylane Laurel MD 20707 Orthodontist Prince Georges<br />
Jones Ronnie Ronnie K Jones DDS 8363 Cherry Ln Laurel MD 20707 Periodontist Prince Georges<br />
Russell Sharon Sharon S Russell DDS 8363 Cherry Lane Laurel MD 20707 Oral Surgeon Prince Georges<br />
Heller Alan Alan R. Heller, D.D.S., M.S. 9811 Mallard Drive, #201 Laurel MD 20708 Orthodontist Prince Georges<br />
Abdullah Aslim Aslim Abdullah, D.D.S. 14333 Laurel-Bowie Rd. # 300 Laurel MD 20708 Endodontist Prince Georges<br />
Baldinger Jill Drs. Levine & Decker 14333 Laurel-Bowie Rd., Suite 201 Laurel MD 20708 Orthodontist Prince Georges<br />
Lavine David Drs. Levine & Decker 14333 Laurel-Bowie Rd., Suite 201 Laurel MD 20708 Orthodontist Prince Georges<br />
Cohen Lisa Maryland Oral Surgery Associates 14333 Laurel Bowie Rd., #205 Laurel MD 20708 Oral Surgeon Prince Georges<br />
Frey Bradley Maryland Oral Surgery Associates 14333 Laurel Bowie Rd., #205 Laurel MD 20708 Oral Surgeon Prince Georges<br />
Griffith Miari-Ann Maryland Oral Surgery Associates 14333 Laurel Bowie Rd., #205 Laurel MD 20708 Oral Surgeon Prince Georges<br />
Kashyap Anil Maryland Oral Surgery Associates 14333 Laurel Bowie Rd., #205 Laurel MD 20708 Oral Surgeon Prince Georges<br />
Patel Chirag Maryland Oral Surgery Associates 14333 Laurel Bowie Rd., #205 Laurel MD 20708 Oral Surgeon Prince Georges<br />
Robinson Brian Maryland Oral Surgery Associates 14333 Laurel Bowie Rd., #205 Laurel MD 20708 Oral Surgeon Prince Georges<br />
Stark Mitchell Maryland Oral Surgery Associates 14333 Laurel Bowie Rd., #205 Laurel MD 20708 Oral Surgeon Prince Georges<br />
Trinh Huy Maryland Oral Surgery Associates 14333 Laurel Bowie Rd., #205 Laurel MD 20708 Oral Surgeon Prince Georges<br />
Criscitiello Kevin 000000002118 Ulery <strong>Dental</strong> & Orthodontics 12793 Laurel Bowie Road Laurel MD 20708 General Provider Prince Georges<br />
DeMizio Peter Ulery <strong>Dental</strong> & Orthodontics 12793 Laurel Bowie Road Laurel MD 20708 Oral Surgeon Prince Georges<br />
Elrafei Mohamed 000000002118 Ulery <strong>Dental</strong> & Orthodontics 12793 Laurel Bowie Road Laurel MD 20708 General Provider Prince Georges<br />
Ganjavian Babak 000000002118 Ulery <strong>Dental</strong> & Orthodontics 12793 Laurel Bowie Road Laurel MD 20708 General Provider Prince Georges<br />
Gentile Michael Ulery <strong>Dental</strong> & Orthodontics 12793 Laurel Bowie Road Laurel MD 20708 Oral Surgeon Prince Georges<br />
Ghajarnia Katayoun 000000002118 Ulery <strong>Dental</strong> & Orthodontics 12793 Laurel Bowie Road Laurel MD 20708 General Provider Prince Georges<br />
Ghajarnia M. Reza Ulery <strong>Dental</strong> & Orthodontics 12793 Laurel Bowie Road Laurel MD 20708 Orthodontist Prince Georges<br />
Jun Sung 000000002118 Ulery <strong>Dental</strong> & Orthodontics 12793 Laurel Bowie Road Laurel MD 20708 General Provider Prince Georges<br />
Mankiewicz Ryan 000000002118 Ulery <strong>Dental</strong> & Orthodontics 12793 Laurel Bowie Road Laurel MD 20708 General Provider Prince Georges<br />
Masood Arif 000000002118 Ulery <strong>Dental</strong> & Orthodontics 12793 Laurel Bowie Road Laurel MD 20708 General Provider Prince Georges<br />
Steinberg Wayne 000000002118 Ulery <strong>Dental</strong> & Orthodontics 12793 Laurel Bowie Road Laurel MD 20708 General Provider Prince Georges<br />
Tchakarova Ludmila 000000002118 Ulery <strong>Dental</strong> & Orthodontics 12793 Laurel Bowie Road Laurel MD 20708 General Provider Prince Georges<br />
Ulery Scott 000000002118 Ulery <strong>Dental</strong> & Orthodontics 12793 Laurel Bowie Road Laurel MD 20708 General Provider Prince Georges<br />
Weiss Karl Ulery <strong>Dental</strong> & Orthodontics 12793 Laurel Bowie Road Laurel MD 20708 Orthodontist Prince Georges<br />
Wolf Christopher 000000002118 Ulery <strong>Dental</strong> & Orthodontics 12793 Laurel Bowie Road Laurel MD 20708 General Provider Prince Georges<br />
Harmon David David E Harmon Jr DDS MSD PA 10264 Lake Arbor Way Mitchellville MD 20721 Orthodontist Prince Georges<br />
Frankenberry Anishka David G. O'Neal, D.D.S., & Assoc. 6188 Oxon Hill Rd., Suite 200 Oxon Hill MD 20745 Orthodontist Prince Georges<br />
O'Neal David 000000000324 David G. O'Neal, D.D.S., & Assoc. 6188 Oxon Hill Rd., Suite 200 Oxon Hill MD 20745 General Provider Prince Georges<br />
Rasul Afia 000000000324 David G. O'Neal, D.D.S., & Assoc. 6188 Oxon Hill Rd., Suite 200 Oxon Hill MD 20745 General Provider Prince Georges<br />
Yalamanchili Padmaja 000000000324 David G. O'Neal, D.D.S., & Assoc. 6188 Oxon Hill Rd., Suite 200 Oxon Hill MD 20745 General Provider Prince Georges<br />
Meyer Emory E Ross Meyer DDS 6130 Oxon Hill Rd, Suite 305 Oxon Hill MD 20745 Oral Surgeon Prince Georges<br />
Monroe Quentin 000000037629 Quentin E Monroe <strong>Dental</strong> <strong>Services</strong> 5448 St. Barnabas Rd. Oxon Hill MD 20745 General Provider Prince Georges<br />
Ruderman Carl Carl Ruderman DDS PA 6315 Baltimore Ave. Riverdale MD 20737 Oral Surgeon Prince Georges<br />
* Blumenfeld Frederick 000000000210 The <strong>Dental</strong> Group 6200 Baltimore Ave., Ste. 200 Riverdale MD 20737 General Provider Prince Georges<br />
* Indicates dentist that is accepting current patients only.<br />
All <strong>Select</strong> <strong>Plan</strong> <strong>Dentist</strong>s Page 8<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 <strong>Dentist</strong>. Fac ID is used to indicate which facility a member chooses.
SELECT PLAN 1 DENTIST DIRECTORY<br />
<strong>Dentist</strong>s listed are under contract as of 9/1/12<br />
Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />
* Digregorio Anthony 000000000210 The <strong>Dental</strong> Group 6200 Baltimore Ave., Ste. 200 Riverdale MD 20737 General Provider Prince Georges<br />
* Pourhmad Haghig Payam 000000000210 The <strong>Dental</strong> Group 6200 Baltimore Ave., Ste. 200 Riverdale MD 20737 General Provider Prince Georges<br />
* Sease, Jr. Tillman 000000000210 The <strong>Dental</strong> Group 6200 Baltimore Ave., Ste. 200 Riverdale MD 20737 General Provider Prince Georges<br />
* Tajick Ramien 000000000210 The <strong>Dental</strong> Group 6200 Baltimore Ave., Ste. 200 Riverdale MD 20737 General Provider Prince Georges<br />
Regil Teresa The <strong>Dental</strong> Group - Teresa Regil, D.D.S. 6200 Baltimore Avenue, Suite 200 Riverdale MD 20737 Pedodontist Prince Georges<br />
Frankle Kathleen The <strong>Dental</strong> Group Specialists 6200 Baltimore Ave. Riverdale MD 20737 Endodontist Prince Georges<br />
Park Sarah The <strong>Dental</strong> Group Specialists 6200 Baltimore Ave. Riverdale MD 20737 Periodontist Prince Georges<br />
Smith Dezrie 000000016470 Suitland <strong>Dental</strong> Center 4814 Silver Hill Road Suitland MD 20746 General Provider Prince Georges<br />
Obianwu Chilo 000000037663 All Smiles <strong>Dental</strong> Care 3847 Branch Ave, Suite 124 Temple Hills MD 20748 General Provider Prince Georges<br />
Kang Sinha 000000079801 <strong>Dental</strong> Associates of Greater MD at Temple Hills 6339 Allentown Road, Suite E Temple Hills MD 20748 General Provider Prince Georges<br />
Park Stanley 000000079801 <strong>Dental</strong> Associates of Greater MD at Temple Hills 6339 Allentown Road, Suite E Temple Hills MD 20748 General Provider Prince Georges<br />
Yoon Jangyeul 000000079801 <strong>Dental</strong> Associates of Greater MD at Temple Hills 6339 Allentown Road, Suite E Temple Hills MD 20748 General Provider Prince Georges<br />
Granger Kevin 000000051072 Oral Health Associates 4316 St Barnabas Rd Temple Hills MD 20748 General Provider Prince Georges<br />
Klapper Harry 000000000187 Harry J. Klapper, D.D.S. 5749 Crain Hwy. Upper Marlboro MD 20772 General Provider Prince Georges<br />
Hlousek Lubor Walzer Sullivan and Hlousek PA 102 Saint Claire Place Stevensville MD 21666 Oral Surgeon Queen Annes<br />
Jones Kurt Walzer Sullivan and Hlousek PA 102 Saint Claire Place Stevensville MD 21666 Oral Surgeon Queen Annes<br />
Sullivan Cornelius Walzer Sullivan and Hlousek PA 102 Saint Claire Place Stevensville MD 21666 Oral Surgeon Queen Annes<br />
Walzer Clifford Walzer Sullivan and Hlousek PA 102 Saint Claire Place Stevensville MD 21666 Oral Surgeon Queen Annes<br />
Doumit Antoine Antoine Doumit DMD CAGS PC 23140 Moakley St, Suite 3 Leonardtown MD 20650 Orthodontist Saint Marys<br />
Robertson Robert 000000000462 Antietam Valley <strong>Dental</strong> Center 1246 Maryland Avenue Hagerstown MD 21740 General Provider Washington<br />
Robertson Robert 000000068461 Antietam Valley <strong>Dental</strong> Center 257 W Main St Hancock MD 21750 General Provider Washington<br />
Ascher Lynn Lynn F. Ascher, D.M.D., P.A. 560 Riverside Drive, Suite B-201 Salisbury MD 21801 Oral Surgeon Wicomico<br />
Forno Donald Eastern Shore Endodontics 1411 Wesley Dr. Salisbury MD 21801 Endodontist Wicomico<br />
Lee Young Eastern Shore Endodontics 1411 Wesley Dr. Salisbury MD 21801 Endodontist Wicomico<br />
Quillin Bartley Eastern Shore Endodontics 1411 Wesley Dr. Salisbury MD 21801 Endodontist Wicomico<br />
Viertl George 000000002319 George C. Viertl, D.D.S., P.C. 560 Riverside Dr., Suite B206 Salisbury MD 21801 General Provider Wicomico<br />
Jain Arvind 000000002767 Delaware Maryland <strong>Dental</strong> 123 West College Ave. Salisbury MD 21804 General Provider Wicomico<br />
Steinberg Robert 000000033847 Robert D Steinberg DDS 11204 Racetrack Rd, Pavillions Suite 102 Ocean Pines MD 21811 General Provider Worcester<br />
Greenberg Jessica North Arlington Orthodontics 64 Ridge Rd. N Arlington NJ 07031 Orthodontist Bergen<br />
Chew Dennis 000000000395 Cosmopolitan <strong>Dental</strong> LLC 10000 Lincoln Dr E, Suite 106 Marlton NJ 08053 General Provider Burlington<br />
Tinkelman Carl Stephen E. Shpeen, D.M.D., PC 30 Jackson Rd., Suite C Medford NJ 08055 Endodontist Burlington<br />
Blumenthal Mitchel 000000002809 American <strong>Dental</strong> Care, PA 61 S. Blackhorse Pike Blackwood NJ 08012 General Provider Camden<br />
Casey Joseph 000000002809 American <strong>Dental</strong> Care, PA 61 S. Blackhorse Pike Blackwood NJ 08012 General Provider Camden<br />
Choksi Raj 000000002809 American <strong>Dental</strong> Care, PA 61 S. Blackhorse Pike Blackwood NJ 08012 General Provider Camden<br />
Costello William 000000002809 American <strong>Dental</strong> Care, PA 61 S. Blackhorse Pike Blackwood NJ 08012 General Provider Camden<br />
Gershkovich Candace 000000002809 American <strong>Dental</strong> Care, PA 61 S. Blackhorse Pike Blackwood NJ 08012 General Provider Camden<br />
Khan Aliya 000000002809 American <strong>Dental</strong> Care, PA 61 S. Blackhorse Pike Blackwood NJ 08012 General Provider Camden<br />
Koff Howard American <strong>Dental</strong> Care, PA 61 S. Blackhorse Pike Blackwood NJ 08012 Orthodontist Camden<br />
Levy Jamie American <strong>Dental</strong> Care, PA 61 S. Blackhorse Pike Blackwood NJ 08012 Oral Surgeon Camden<br />
Li Fuming 000000002809 American <strong>Dental</strong> Care, PA 61 S. Blackhorse Pike Blackwood NJ 08012 General Provider Camden<br />
Morgenstern Thomas American <strong>Dental</strong> Care, PA 61 S. Blackhorse Pike Blackwood NJ 08012 Orthodontist Camden<br />
Ruggieri John 000000002809 American <strong>Dental</strong> Care, PA 61 S. Blackhorse Pike Blackwood NJ 08012 General Provider Camden<br />
Gelman Robert 000000000661 Gelman <strong>Dental</strong> Associates 639 Market Street Camden NJ 08102 General Provider Camden<br />
Kaye Gary 000000000661 Gelman <strong>Dental</strong> Associates 639 Market Street Camden NJ 08102 General Provider Camden<br />
Bandola Krystin Matthew Eichen, D.M.D., P.A. 17 W. Ormond Ave Cherry Hill NJ 08034 Oral Surgeon Camden<br />
Chi Kai-Zu Matthew Eichen, D.M.D., P.A. 17 W. Ormond Ave Cherry Hill NJ 08034 Oral Surgeon Camden<br />
Eichen Matthew Matthew Eichen, D.M.D., P.A. 17 W. Ormond Ave Cherry Hill NJ 08034 Oral Surgeon Camden<br />
* Friedland Gary 000000000717 Fries Mill <strong>Dental</strong> Associates, P.A. 188 Fries Mill Road, L-3 Turnersville NJ 08012 General Provider Camden<br />
Casey Joseph 000000002864 American <strong>Dental</strong> Care, PA 2 Sheppard Rd., Suite 100 Voorhees NJ 08043 General Provider Camden<br />
Choksi Raj 000000002864 American <strong>Dental</strong> Care, PA 2 Sheppard Rd., Suite 100 Voorhees NJ 08043 General Provider Camden<br />
Costello William 000000002864 American <strong>Dental</strong> Care, PA 2 Sheppard Rd., Suite 100 Voorhees NJ 08043 General Provider Camden<br />
Gershkovich Candace 000000002864 American <strong>Dental</strong> Care, PA 2 Sheppard Rd., Suite 100 Voorhees NJ 08043 General Provider Camden<br />
Khan Aliya 000000002864 American <strong>Dental</strong> Care, PA 2 Sheppard Rd., Suite 100 Voorhees NJ 08043 General Provider Camden<br />
Koff Howard American <strong>Dental</strong> Care, PA 2 Sheppard Rd., Suite 100 Voorhees NJ 08043 Orthodontist Camden<br />
Li Fuming 000000002864 American <strong>Dental</strong> Care, PA 2 Sheppard Rd., Suite 100 Voorhees NJ 08043 General Provider Camden<br />
Morgenstern Thomas American <strong>Dental</strong> Care, PA 2 Sheppard Rd., Suite 100 Voorhees NJ 08043 Orthodontist Camden<br />
Ruggieri John 000000002864 American <strong>Dental</strong> Care, PA 2 Sheppard Rd., Suite 100 Voorhees NJ 08043 General Provider Camden<br />
Mashru Poonam 000000050733 Family <strong>Dental</strong> Care of South Jersey 707 Haddonfield Berlin Road Voorhees NJ 08043 General Provider Camden<br />
Schupper Jeffrey 000000050733 Family <strong>Dental</strong> Care of South Jersey 707 Haddonfield Berlin Road Voorhees NJ 08043 General Provider Camden<br />
Tenbrook James Tenbrook Orthodontics 508 Shiloh Pike Bridgeton NJ 08302 Orthodontist Cumberland<br />
Tenbrook James Tenbrook Orthodontics 1030 N High Street Millville NJ 08332 Orthodontist Cumberland<br />
Tenbrook James Tenbrook Orthodontics 1101 Wheaton Ave Millville NJ 08332 Orthodontist Cumberland<br />
Bandola Krystin Matthew Eichen, D.M.D., P.A. 83 S State St Vineland NJ 08360 Oral Surgeon Cumberland<br />
Chi Kai-Zu Matthew Eichen, D.M.D., P.A. 83 S State St Vineland NJ 08360 Oral Surgeon Cumberland<br />
Eichen Matthew Matthew Eichen, D.M.D., P.A. 83 S State St Vineland NJ 08360 Oral Surgeon Cumberland<br />
Tenbrook James Tenbrook Orthodontics 630 Brewster Rd, Unit D-1 Vineland NJ 08361 Orthodontist Cumberland<br />
* Indicates dentist that is accepting current patients only.<br />
All <strong>Select</strong> <strong>Plan</strong> <strong>Dentist</strong>s Page 9<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 <strong>Dentist</strong>. Fac ID is used to indicate which facility a member chooses.
SELECT PLAN 1 DENTIST DIRECTORY<br />
<strong>Dentist</strong>s listed are under contract as of 9/1/12<br />
Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />
Pericci Jeffrey 000000000724 Jeffrey M. Perricci, D.M.D. 123 Van Buren Street Newark NJ 07105 General Provider Essex<br />
Azizogli Amer 000000000834 Amer Azizogli, D.D.S. 175 Franklin Ave., Suite 101 Nutley NJ 07110 General Provider Essex<br />
Casey Joseph 000000002806 American <strong>Dental</strong> Care, PA 1450 Clements Bridge Rd. Deptford NJ 08096 General Provider Gloucester<br />
Choksi Raj 000000002806 American <strong>Dental</strong> Care, PA 1450 Clements Bridge Rd. Deptford NJ 08096 General Provider Gloucester<br />
Costello William 000000002806 American <strong>Dental</strong> Care, PA 1450 Clements Bridge Rd. Deptford NJ 08096 General Provider Gloucester<br />
Gacita Anthony 000000002806 American <strong>Dental</strong> Care, PA 1450 Clements Bridge Rd. Deptford NJ 08096 General Provider Gloucester<br />
Gershkovich Candace 000000002806 American <strong>Dental</strong> Care, PA 1450 Clements Bridge Rd. Deptford NJ 08096 General Provider Gloucester<br />
Khan Aliya 000000002806 American <strong>Dental</strong> Care, PA 1450 Clements Bridge Rd. Deptford NJ 08096 General Provider Gloucester<br />
Koff Howard American <strong>Dental</strong> Care, PA 1450 Clements Bridge Rd. Deptford NJ 08096 Orthodontist Gloucester<br />
Li Fuming 000000002806 American <strong>Dental</strong> Care, PA 1450 Clements Bridge Rd. Deptford NJ 08096 General Provider Gloucester<br />
Morgenstern Thomas American <strong>Dental</strong> Care, PA 1450 Clements Bridge Rd. Deptford NJ 08096 Orthodontist Gloucester<br />
Ruggieri John 000000002806 American <strong>Dental</strong> Care, PA 1450 Clements Bridge Rd. Deptford NJ 08096 General Provider Gloucester<br />
Shamseddin Seyed American <strong>Dental</strong> Care, PA 1450 Clements Bridge Rd. Deptford NJ 08096 Periodontist Gloucester<br />
Tenbrook James Tenbrook Orthodontics 108 Route 322, Unit 3 Mullica Hill NJ 08062 Orthodontist Gloucester<br />
Tenbrook James Tenbrook Orthodontics 304 Hurffville Crosskeys Rd Sewell NJ 08080 Orthodontist Gloucester<br />
Eslami Ali 000000001305 Turnersville Family <strong>Dentist</strong>ry 123 Eggharbor Rd. Sewell NJ 08080 General Provider Gloucester<br />
Tenbrook James Tenbrook Orthodontics 1630 Route 322, Suite B Woolwich Township NJ 08085 Orthodontist Gloucester<br />
Gerhard Ronald Ronald F Gerhard DDS PA 834 Avenue C Bayonne NJ 07002 Periodontist Hudson<br />
Vahid Arash 000000072101 AV <strong>Dental</strong> Associates PA 642 Newark Ave Jersey City NJ 07306 General Provider Hudson<br />
Pericci Jeffrey 000000000714 Jeffrey M. Perricci, D.M.D. 594 Kearny Avenue, P.O. Box 523 Kearny NJ 07032 General Provider Hudson<br />
Eisenberg Adam 000000000685 Adam G. Eisenberg, D.D.S. 710 Alexander Rd. Princeton NJ 08540 General Provider Mercer<br />
Patel Priya 000000033850 Personalized <strong>Dental</strong> Care, P.C. 805 Inman Ave Colonia NJ 07067 General Provider Middlesex<br />
Eisenberg Adam 000000000485 Adam G. Eisenberg, D.D.S. Central Mediplex, 495 Iron Bridge Rd. #9 Freehold NJ 07728 General Provider Monmouth<br />
Eisenberg Adam 000000037713 Drs. Eisenberg of Ocean 2002 Sunset Ave Ocean NJ 07712 General Provider Monmouth<br />
Gerhard Ronald Ronald F Gerhard DDS PA 225 Highway 35 Red Bank NJ 07701 Periodontist Monmouth<br />
Tenbrook James Tenbrook Orthodontics 8596 Route 40 / Route 45 Woodstown NJ 08098 Orthodontist Salem<br />
Anithottam Abraham Abraham Joseph Anithottam 390 Amwell Road, Suite 102 Hillsborough NJ 08844 Orthodontist Somerset<br />
Karandikar Rajashree 000000079090 Manville <strong>Dental</strong> Group LLC 7 Washington Ave Manville NJ 08835 General Provider Somerset<br />
Small Gary 000000079090 Manville <strong>Dental</strong> Group LLC 7 Washington Ave Manville NJ 08835 General Provider Somerset<br />
Trivedi Nirali 000000079090 Manville <strong>Dental</strong> Group LLC 7 Washington Ave Manville NJ 08835 General Provider Somerset<br />
Wadhwa Nandhi 000000079090 Manville <strong>Dental</strong> Group LLC 7 Washington Ave Manville NJ 08835 General Provider Somerset<br />
Emmert Richard 000000001487 Emmert <strong>Dental</strong> Associates, P.C. 2404 Oxford Drive Bethel Park PA 15102 General Provider Allegheny<br />
Manalo Arsenio 000000001209 Manalo Family <strong>Dentist</strong>ry, P.C. 2414 Lytle Rd.,Ste. 106 Bethel Park PA 15102 General Provider Allegheny<br />
Adams William 000000000985 Katsur <strong>Dental</strong> & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 General Provider Allegheny<br />
Affolter John 000000000985 Katsur <strong>Dental</strong> & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 General Provider Allegheny<br />
Alagirisamy Kiruthika 000000000985 Katsur <strong>Dental</strong> & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 General Provider Allegheny<br />
Carozza Roselyn 000000000985 Katsur <strong>Dental</strong> & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 General Provider Allegheny<br />
Cohen Ira 000000000985 Katsur <strong>Dental</strong> & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 General Provider Allegheny<br />
Dahar Nicholas Katsur <strong>Dental</strong> & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 Orthodontist Allegheny<br />
Damich Louis 000000000985 Katsur <strong>Dental</strong> & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 General Provider Allegheny<br />
Ghaffari Catherine 000000000985 Katsur <strong>Dental</strong> & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 General Provider Allegheny<br />
Ghajarnia M. Reza Katsur <strong>Dental</strong> & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 Orthodontist Allegheny<br />
Gillen Steve 000000000985 Katsur <strong>Dental</strong> & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 General Provider Allegheny<br />
Iszkula Steven Katsur <strong>Dental</strong> & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 Orthodontist Allegheny<br />
Katsur James 000000000985 Katsur <strong>Dental</strong> & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 General Provider Allegheny<br />
Khurana Leena 000000000985 Katsur <strong>Dental</strong> & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 General Provider Allegheny<br />
Kier Calvin 000000000985 Katsur <strong>Dental</strong> & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 General Provider Allegheny<br />
King David Katsur <strong>Dental</strong> & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 Orthodontist Allegheny<br />
Kolla Siva 000000000985 Katsur <strong>Dental</strong> & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 General Provider Allegheny<br />
Lewis Howell Katsur <strong>Dental</strong> & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 Orthodontist Allegheny<br />
Miller Van Katsur <strong>Dental</strong> & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 Orthodontist Allegheny<br />
Pryor Leroy 000000000985 Katsur <strong>Dental</strong> & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 General Provider Allegheny<br />
Rinchuse Dara Katsur <strong>Dental</strong> & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 Orthodontist Allegheny<br />
Schmidt Alan 000000000985 Katsur <strong>Dental</strong> & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 General Provider Allegheny<br />
Smiga Ingrid 000000000985 Katsur <strong>Dental</strong> & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 General Provider Allegheny<br />
Stein Mark 000000000985 Katsur <strong>Dental</strong> & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 General Provider Allegheny<br />
Tinnemeyer Anjuli 000000000985 Katsur <strong>Dental</strong> & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 General Provider Allegheny<br />
Zalakar Frank 000000000985 Katsur <strong>Dental</strong> & Orthodontics 1597 Washington Pike, Suite A5 Bridgeville PA 15017 General Provider Allegheny<br />
Dandashi Moutaz Katsur <strong>Dental</strong> & Orthodontics Specialists 1597 Washington Pike, Suite A5 Bridgeville PA 15017 Pedodontist Allegheny<br />
Hertzler L Gregory Katsur <strong>Dental</strong> & Orthodontics Specialists 1597 Washington Pike, Suite A5 Bridgeville PA 15017 Oral Surgeon Allegheny<br />
Kelly Derek Katsur <strong>Dental</strong> & Orthodontics Specialists 1597 Washington Pike, Suite A5 Bridgeville PA 15017 Oral Surgeon Allegheny<br />
Kier Gregory Katsur <strong>Dental</strong> & Orthodontics Specialists 1597 Washington Pike, Suite A5 Bridgeville PA 15017 Periodontist Allegheny<br />
Monti Richard Katsur <strong>Dental</strong> & Orthodontics Specialists 1597 Washington Pike, Suite A5 Bridgeville PA 15017 Oral Surgeon Allegheny<br />
Iurlano David 000000001246 David Iurlano, D.M.D. 1101 Fifth Ave. Coraopolis PA 15108 General Provider Allegheny<br />
Mancini James 000000001280 James Mancini, D.M.D., P.C. 327 Forest Grove Rd. Coraopolis PA 15108 General Provider Allegheny<br />
Wintner Morton Morton Wintner, D.M.D. 850 Beaver Grade Rd. Coraopolis PA 15108 Orthodontist Allegheny<br />
* Indicates dentist that is accepting current patients only.<br />
All <strong>Select</strong> <strong>Plan</strong> <strong>Dentist</strong>s Page 10<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 <strong>Dentist</strong>. Fac ID is used to indicate which facility a member chooses.
SELECT PLAN 1 DENTIST DIRECTORY<br />
<strong>Dentist</strong>s listed are under contract as of 9/1/12<br />
Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />
Affolter John 000000002117 Katsur <strong>Dental</strong> & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 General Provider Allegheny<br />
Alagirisamy Kiruthika 000000002117 Katsur <strong>Dental</strong> & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 General Provider Allegheny<br />
Carozza Roselyn 000000002117 Katsur <strong>Dental</strong> & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 General Provider Allegheny<br />
Cohen Ira 000000002117 Katsur <strong>Dental</strong> & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 General Provider Allegheny<br />
Dahar Nicholas Katsur <strong>Dental</strong> & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 Orthodontist Allegheny<br />
Damich Louis 000000002117 Katsur <strong>Dental</strong> & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 General Provider Allegheny<br />
Dandashi Moutaz Katsur <strong>Dental</strong> & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 Pedodontist Allegheny<br />
Ghaffari Catherine 000000002117 Katsur <strong>Dental</strong> & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 General Provider Allegheny<br />
Ghajarnia M. Reza Katsur <strong>Dental</strong> & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 Orthodontist Allegheny<br />
Gillen Steve 000000002117 Katsur <strong>Dental</strong> & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 General Provider Allegheny<br />
Hertzler L Gregory Katsur <strong>Dental</strong> & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 Oral Surgeon Allegheny<br />
Iszkula Steven Katsur <strong>Dental</strong> & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 Orthodontist Allegheny<br />
Katsur James 000000002117 Katsur <strong>Dental</strong> & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 General Provider Allegheny<br />
Kelly Derek Katsur <strong>Dental</strong> & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 Oral Surgeon Allegheny<br />
Khurana Leena 000000002117 Katsur <strong>Dental</strong> & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 General Provider Allegheny<br />
Kier Calvin 000000002117 Katsur <strong>Dental</strong> & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 General Provider Allegheny<br />
Kier Gregory Katsur <strong>Dental</strong> & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 Periodontist Allegheny<br />
King David Katsur <strong>Dental</strong> & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 Orthodontist Allegheny<br />
Kolla Siva 000000002117 Katsur <strong>Dental</strong> & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 General Provider Allegheny<br />
Lewis Howell Katsur <strong>Dental</strong> & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 Orthodontist Allegheny<br />
Miller Van Katsur <strong>Dental</strong> & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 Orthodontist Allegheny<br />
Pryor Leroy 000000002117 Katsur <strong>Dental</strong> & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 General Provider Allegheny<br />
Rinchuse Dara Katsur <strong>Dental</strong> & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 Orthodontist Allegheny<br />
Schmidt Alan 000000002117 Katsur <strong>Dental</strong> & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 General Provider Allegheny<br />
Smiga Ingrid 000000002117 Katsur <strong>Dental</strong> & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 General Provider Allegheny<br />
Stein Mark 000000002117 Katsur <strong>Dental</strong> & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 General Provider Allegheny<br />
Zalakar Frank 000000002117 Katsur <strong>Dental</strong> & Orthodontics 1724 Mount Royal Blvd. Glenshaw PA 15116 General Provider Allegheny<br />
Bonczek Brian 000000051012 Aspen <strong>Dental</strong> 240 Waterfront Dr E Homestead PA 15120 General Provider Allegheny<br />
Ciarallo Robert Aspen <strong>Dental</strong> 240 Waterfront Dr E Homestead PA 15120 Oral Surgeon Allegheny<br />
Grinberg Anna 000000051012 Aspen <strong>Dental</strong> 240 Waterfront Dr E Homestead PA 15120 General Provider Allegheny<br />
Monaco Natalie 000000051012 Aspen <strong>Dental</strong> 240 Waterfront Dr E Homestead PA 15120 General Provider Allegheny<br />
Ruprecht Heather 000000051012 Aspen <strong>Dental</strong> 240 Waterfront Dr E Homestead PA 15120 General Provider Allegheny<br />
Shieh Andy 000000051012 Aspen <strong>Dental</strong> 240 Waterfront Dr E Homestead PA 15120 General Provider Allegheny<br />
Schwimer Charles Charles W. Schwimer, D.M.D. 6201 Steubenville Pike Mc Kees Rocks PA 15136 Periodontist Allegheny<br />
Wintner Morton Morton S. Wintner, D.M.D. 6000 Steubenville Pike Mc Kees Rocks PA 15136 Orthodontist Allegheny<br />
Adams William 000000001077 Katsur <strong>Dental</strong> & Orthodontics 820 Fifth Avenue Mc Keesport PA 15132 General Provider Allegheny<br />
Affolter John 000000001077 Katsur <strong>Dental</strong> & Orthodontics 820 Fifth Avenue Mc Keesport PA 15132 General Provider Allegheny<br />
Alagirisamy Kiruthika 000000001077 Katsur <strong>Dental</strong> & Orthodontics 820 Fifth Avenue Mc Keesport PA 15132 General Provider Allegheny<br />
Carozza Roselyn 000000001077 Katsur <strong>Dental</strong> & Orthodontics 820 Fifth Avenue Mc Keesport PA 15132 General Provider Allegheny<br />
Cohen Ira 000000001077 Katsur <strong>Dental</strong> & Orthodontics 820 Fifth Avenue Mc Keesport PA 15132 General Provider Allegheny<br />
Dahar Nicholas Katsur <strong>Dental</strong> & Orthodontics 820 Fifth Avenue Mc Keesport PA 15132 Orthodontist Allegheny<br />
Damich Louis 000000001077 Katsur <strong>Dental</strong> & Orthodontics 820 Fifth Avenue Mc Keesport PA 15132 General Provider Allegheny<br />
Ghaffari Catherine 000000001077 Katsur <strong>Dental</strong> & Orthodontics 820 Fifth Avenue Mc Keesport PA 15132 General Provider Allegheny<br />
Ghajarnia M. Reza Katsur <strong>Dental</strong> & Orthodontics 820 Fifth Avenue Mc Keesport PA 15132 Orthodontist Allegheny<br />
Gillen Steve 000000001077 Katsur <strong>Dental</strong> & Orthodontics 820 Fifth Avenue Mc Keesport PA 15132 General Provider Allegheny<br />
Iszkula Steven Katsur <strong>Dental</strong> & Orthodontics 820 Fifth Avenue Mc Keesport PA 15132 Orthodontist Allegheny<br />
Katsur James 000000001077 Katsur <strong>Dental</strong> & Orthodontics 820 Fifth Avenue Mc Keesport PA 15132 General Provider Allegheny<br />
Khurana Leena 000000001077 Katsur <strong>Dental</strong> & Orthodontics 820 Fifth Avenue Mc Keesport PA 15132 General Provider Allegheny<br />
Kier Calvin 000000001077 Katsur <strong>Dental</strong> & Orthodontics 820 Fifth Avenue Mc Keesport PA 15132 General Provider Allegheny<br />
King David Katsur <strong>Dental</strong> & Orthodontics 820 Fifth Avenue Mc Keesport PA 15132 Orthodontist Allegheny<br />
Kolla Siva 000000001077 Katsur <strong>Dental</strong> & Orthodontics 820 Fifth Avenue Mc Keesport PA 15132 General Provider Allegheny<br />
Lewis Howell Katsur <strong>Dental</strong> & Orthodontics 820 Fifth Avenue Mc Keesport PA 15132 Orthodontist Allegheny<br />
Miller Van Katsur <strong>Dental</strong> & Orthodontics 820 Fifth Avenue Mc Keesport PA 15132 Orthodontist Allegheny<br />
Pryor Leroy 000000001077 Katsur <strong>Dental</strong> & Orthodontics 820 Fifth Avenue Mc Keesport PA 15132 General Provider Allegheny<br />
Rinchuse Dara Katsur <strong>Dental</strong> & Orthodontics 820 Fifth Avenue Mc Keesport PA 15132 Orthodontist Allegheny<br />
Schmidt Alan 000000001077 Katsur <strong>Dental</strong> & Orthodontics 820 Fifth Avenue Mc Keesport PA 15132 General Provider Allegheny<br />
Smiga Ingrid 000000001077 Katsur <strong>Dental</strong> & Orthodontics 820 Fifth Avenue Mc Keesport PA 15132 General Provider Allegheny<br />
Stein Mark 000000001077 Katsur <strong>Dental</strong> & Orthodontics 820 Fifth Avenue Mc Keesport PA 15132 General Provider Allegheny<br />
Tinnemeyer Anjuli 000000001077 Katsur <strong>Dental</strong> & Orthodontics 820 Fifth Avenue Mc Keesport PA 15132 General Provider Allegheny<br />
Zalakar Frank 000000001077 Katsur <strong>Dental</strong> & Orthodontics 820 Fifth Avenue Mc Keesport PA 15132 General Provider Allegheny<br />
Strobel Bradford 000000001449 Bradford E. Strobel, D.M.D. 5949 Steubenville Pike McKees Rocks PA 15136 General Provider Allegheny<br />
Monaco Natalie 000000050881 McKees Rocks <strong>Dental</strong> 757 Chartiers Ave McKees Rocks PA 15136 General Provider Allegheny<br />
Dandashi Moutaz Katsur <strong>Dental</strong> & Orthodontics Specialists 820 5th Ave McKeesport PA 15132 Pedodontist Allegheny<br />
Hertzler L Gregory Katsur <strong>Dental</strong> & Orthodontics Specialists 820 5th Ave McKeesport PA 15132 Oral Surgeon Allegheny<br />
Kelly Derek Katsur <strong>Dental</strong> & Orthodontics Specialists 820 5th Ave McKeesport PA 15132 Oral Surgeon Allegheny<br />
Kier Gregory Katsur <strong>Dental</strong> & Orthodontics Specialists 820 5th Ave McKeesport PA 15132 Periodontist Allegheny<br />
* Indicates dentist that is accepting current patients only.<br />
All <strong>Select</strong> <strong>Plan</strong> <strong>Dentist</strong>s Page 11<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 <strong>Dentist</strong>. Fac ID is used to indicate which facility a member chooses.
SELECT PLAN 1 DENTIST DIRECTORY<br />
<strong>Dentist</strong>s listed are under contract as of 9/1/12<br />
Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />
Monti Richard Katsur <strong>Dental</strong> & Orthodontics Specialists 820 5th Ave McKeesport PA 15132 Oral Surgeon Allegheny<br />
Ayoub Samir 000000001364 Samir J. Ayoub, D.M.D. 4304 Walnut Street McKeesport PA 15132 General Provider Allegheny<br />
Dargan Monica 000000001590 Chestnut Hills <strong>Dental</strong> 320 Center Rd. Monroeville PA 15146 General Provider Allegheny<br />
DiCristofaro Dean 000000001590 Chestnut Hills <strong>Dental</strong> 320 Center Rd. Monroeville PA 15146 General Provider Allegheny<br />
Gusmerotti Gary 000000001590 Chestnut Hills <strong>Dental</strong> 320 Center Rd. Monroeville PA 15146 General Provider Allegheny<br />
Hudock Robert 000000001590 Chestnut Hills <strong>Dental</strong> 320 Center Rd. Monroeville PA 15146 General Provider Allegheny<br />
Sassouni Anouk Chestnut Hills <strong>Dental</strong> 320 Center Rd. Monroeville PA 15146 Orthodontist Allegheny<br />
Strezo Kevin 000000001590 Chestnut Hills <strong>Dental</strong> 320 Center Rd. Monroeville PA 15146 General Provider Allegheny<br />
Shensa David Chestnut Hills <strong>Dental</strong> Specialists 320 Center Rd Monroeville PA 15146 Oral Surgeon Allegheny<br />
Adams William 000000001074 Katsur <strong>Dental</strong> & Orthodontics 2644 Mosside Blvd. Monroeville PA 15146 General Provider Allegheny<br />
Affolter John 000000001074 Katsur <strong>Dental</strong> & Orthodontics 2644 Mosside Blvd. Monroeville PA 15146 General Provider Allegheny<br />
Alagirisamy Kiruthika 000000001074 Katsur <strong>Dental</strong> & Orthodontics 2644 Mosside Blvd. Monroeville PA 15146 General Provider Allegheny<br />
Carozza Roselyn 000000001074 Katsur <strong>Dental</strong> & Orthodontics 2644 Mosside Blvd. Monroeville PA 15146 General Provider Allegheny<br />
Cohen Ira 000000001074 Katsur <strong>Dental</strong> & Orthodontics 2644 Mosside Blvd. Monroeville PA 15146 General Provider Allegheny<br />
Dahar Nicholas Katsur <strong>Dental</strong> & Orthodontics 2644 Mosside Blvd. Monroeville PA 15146 Orthodontist Allegheny<br />
Damich Louis 000000001074 Katsur <strong>Dental</strong> & Orthodontics 2644 Mosside Blvd. Monroeville PA 15146 General Provider Allegheny<br />
Ghaffari Catherine 000000001074 Katsur <strong>Dental</strong> & Orthodontics 2644 Mosside Blvd. Monroeville PA 15146 General Provider Allegheny<br />
Ghajarnia M. Reza Katsur <strong>Dental</strong> & Orthodontics 2644 Mosside Blvd. Monroeville PA 15146 Orthodontist Allegheny<br />
Gillen Steve 000000001074 Katsur <strong>Dental</strong> & Orthodontics 2644 Mosside Blvd. Monroeville PA 15146 General Provider Allegheny<br />
Iszkula Steven Katsur <strong>Dental</strong> & Orthodontics 2644 Mosside Blvd. Monroeville PA 15146 Orthodontist Allegheny<br />
Katsur James 000000001074 Katsur <strong>Dental</strong> & Orthodontics 2644 Mosside Blvd. Monroeville PA 15146 General Provider Allegheny<br />
Khurana Leena 000000001074 Katsur <strong>Dental</strong> & Orthodontics 2644 Mosside Blvd. Monroeville PA 15146 General Provider Allegheny<br />
Kier Calvin 000000001074 Katsur <strong>Dental</strong> & Orthodontics 2644 Mosside Blvd. Monroeville PA 15146 General Provider Allegheny<br />
King David Katsur <strong>Dental</strong> & Orthodontics 2644 Mosside Blvd. Monroeville PA 15146 Orthodontist Allegheny<br />
Kolla Siva 000000001074 Katsur <strong>Dental</strong> & Orthodontics 2644 Mosside Blvd. Monroeville PA 15146 General Provider Allegheny<br />
Lewis Howell Katsur <strong>Dental</strong> & Orthodontics 2644 Mosside Blvd. Monroeville PA 15146 Orthodontist Allegheny<br />
Miller Van Katsur <strong>Dental</strong> & Orthodontics 2644 Mosside Blvd. Monroeville PA 15146 Orthodontist Allegheny<br />
Pryor Leroy 000000001074 Katsur <strong>Dental</strong> & Orthodontics 2644 Mosside Blvd. Monroeville PA 15146 General Provider Allegheny<br />
Rinchuse Dara Katsur <strong>Dental</strong> & Orthodontics 2644 Mosside Blvd. Monroeville PA 15146 Orthodontist Allegheny<br />
Schmidt Alan 000000001074 Katsur <strong>Dental</strong> & Orthodontics 2644 Mosside Blvd. Monroeville PA 15146 General Provider Allegheny<br />
Smiga Ingrid 000000001074 Katsur <strong>Dental</strong> & Orthodontics 2644 Mosside Blvd. Monroeville PA 15146 General Provider Allegheny<br />
Stein Mark 000000001074 Katsur <strong>Dental</strong> & Orthodontics 2644 Mosside Blvd. Monroeville PA 15146 General Provider Allegheny<br />
Tinnemeyer Anjuli 000000001074 Katsur <strong>Dental</strong> & Orthodontics 2644 Mosside Blvd. Monroeville PA 15146 General Provider Allegheny<br />
Zalakar Frank 000000001074 Katsur <strong>Dental</strong> & Orthodontics 2644 Mosside Blvd. Monroeville PA 15146 General Provider Allegheny<br />
Dandashi Moutaz Katsur <strong>Dental</strong> & Orthodontics Specialists 2644 Mosside Blvd Monroeville PA 15146 Pedodontist Allegheny<br />
Hertzler L Gregory Katsur <strong>Dental</strong> & Orthodontics Specialists 2644 Mosside Blvd Monroeville PA 15146 Oral Surgeon Allegheny<br />
Kelly Derek Katsur <strong>Dental</strong> & Orthodontics Specialists 2644 Mosside Blvd Monroeville PA 15146 Oral Surgeon Allegheny<br />
Kier Gregory Katsur <strong>Dental</strong> & Orthodontics Specialists 2644 Mosside Blvd Monroeville PA 15146 Periodontist Allegheny<br />
Monti Richard Katsur <strong>Dental</strong> & Orthodontics Specialists 2644 Mosside Blvd Monroeville PA 15146 Oral Surgeon Allegheny<br />
Grimes Michael Michael L. Grimes, D.M.D. 2550 Mosside Blvd., Ste. 213 Monroeville PA 15146 Pedodontist Allegheny<br />
Thomas Arnold 000000001640 Arnold W. Thomas, D.M.D., P.C. 1000 Commerce Street, Suite 108 Moon Township PA 15108 General Provider Allegheny<br />
Skoff David 000000001432 David M. Skoff, D.M.D., P.C. 850 Beaver Grade Road Moon Township PA 15108 General Provider Allegheny<br />
Skoff Joseph 000000001432 David M. Skoff, D.M.D., P.C. 850 Beaver Grade Road Moon Township PA 15108 General Provider Allegheny<br />
Sofranko Kenneth 000000001509 Kenneth M. Sofranko, D.M.D. 928 Brodhead Road Moon Township PA 15108 General Provider Allegheny<br />
Lee Phyllis 000000070988 Prosthetic <strong>Dentist</strong>ry of Mt Lebanon PC 603 Washington Rd, Suite 200 Mount Lebanon PA 15228 General Provider Allegheny<br />
Dunn Stephen 000000002205 Munhall <strong>Dental</strong> 4101 McWhinney Street Munhall PA 15120 General Provider Allegheny<br />
Chernoff Herbert 000000001245 Herbert Chernoff, D.M.D. 500 Lincoln Hwy. N Versailles PA 15137 General Provider Allegheny<br />
Kreashko Robert Kreashko Orthodontics 1601 Union Ave. Natrona Heights PA 15065 Orthodontist Allegheny<br />
Adams William 000000001071 Katsur <strong>Dental</strong> & Orthodontics 1955 Wharton St. Pittsburgh PA 15203 General Provider Allegheny<br />
Affolter John 000000001071 Katsur <strong>Dental</strong> & Orthodontics 1955 Wharton St. Pittsburgh PA 15203 General Provider Allegheny<br />
Alagirisamy Kiruthika 000000001071 Katsur <strong>Dental</strong> & Orthodontics 1955 Wharton St. Pittsburgh PA 15203 General Provider Allegheny<br />
Carozza Roselyn 000000001071 Katsur <strong>Dental</strong> & Orthodontics 1955 Wharton St. Pittsburgh PA 15203 General Provider Allegheny<br />
Cohen Ira 000000001071 Katsur <strong>Dental</strong> & Orthodontics 1955 Wharton St. Pittsburgh PA 15203 General Provider Allegheny<br />
Dahar Nicholas Katsur <strong>Dental</strong> & Orthodontics 1955 Wharton St. Pittsburgh PA 15203 Orthodontist Allegheny<br />
Damich Louis 000000001071 Katsur <strong>Dental</strong> & Orthodontics 1955 Wharton St. Pittsburgh PA 15203 General Provider Allegheny<br />
Ghaffari Catherine 000000001071 Katsur <strong>Dental</strong> & Orthodontics 1955 Wharton St. Pittsburgh PA 15203 General Provider Allegheny<br />
Ghajarnia M. Reza Katsur <strong>Dental</strong> & Orthodontics 1955 Wharton St. Pittsburgh PA 15203 Orthodontist Allegheny<br />
Gillen Steve 000000001071 Katsur <strong>Dental</strong> & Orthodontics 1955 Wharton St. Pittsburgh PA 15203 General Provider Allegheny<br />
Iszkula Steven Katsur <strong>Dental</strong> & Orthodontics 1955 Wharton St. Pittsburgh PA 15203 Orthodontist Allegheny<br />
Katsur James 000000001071 Katsur <strong>Dental</strong> & Orthodontics 1955 Wharton St. Pittsburgh PA 15203 General Provider Allegheny<br />
Khurana Leena 000000001071 Katsur <strong>Dental</strong> & Orthodontics 1955 Wharton St. Pittsburgh PA 15203 General Provider Allegheny<br />
Kier Calvin 000000001071 Katsur <strong>Dental</strong> & Orthodontics 1955 Wharton St. Pittsburgh PA 15203 General Provider Allegheny<br />
King David Katsur <strong>Dental</strong> & Orthodontics 1955 Wharton St. Pittsburgh PA 15203 Orthodontist Allegheny<br />
Kolla Siva 000000001071 Katsur <strong>Dental</strong> & Orthodontics 1955 Wharton St. Pittsburgh PA 15203 General Provider Allegheny<br />
Lewis Howell Katsur <strong>Dental</strong> & Orthodontics 1955 Wharton St. Pittsburgh PA 15203 Orthodontist Allegheny<br />
Miller Van Katsur <strong>Dental</strong> & Orthodontics 1955 Wharton St. Pittsburgh PA 15203 Orthodontist Allegheny<br />
* Indicates dentist that is accepting current patients only.<br />
All <strong>Select</strong> <strong>Plan</strong> <strong>Dentist</strong>s Page 12<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 <strong>Dentist</strong>. Fac ID is used to indicate which facility a member chooses.
SELECT PLAN 1 DENTIST DIRECTORY<br />
<strong>Dentist</strong>s listed are under contract as of 9/1/12<br />
Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />
Pryor Leroy 000000001071 Katsur <strong>Dental</strong> & Orthodontics 1955 Wharton St. Pittsburgh PA 15203 General Provider Allegheny<br />
Rinchuse Dara Katsur <strong>Dental</strong> & Orthodontics 1955 Wharton St. Pittsburgh PA 15203 Orthodontist Allegheny<br />
Schmidt Alan 000000001071 Katsur <strong>Dental</strong> & Orthodontics 1955 Wharton St. Pittsburgh PA 15203 General Provider Allegheny<br />
Smiga Ingrid 000000001071 Katsur <strong>Dental</strong> & Orthodontics 1955 Wharton St. Pittsburgh PA 15203 General Provider Allegheny<br />
Stein Mark 000000001071 Katsur <strong>Dental</strong> & Orthodontics 1955 Wharton St. Pittsburgh PA 15203 General Provider Allegheny<br />
Tinnemeyer Anjuli 000000001071 Katsur <strong>Dental</strong> & Orthodontics 1955 Wharton St. Pittsburgh PA 15203 General Provider Allegheny<br />
Dandashi Moutaz Katsur <strong>Dental</strong> & Orthodontics Specialists 1955 Wharton St Pittsburgh PA 15203 Pedodontist Allegheny<br />
Hertzler L Gregory Katsur <strong>Dental</strong> & Orthodontics Specialists 1955 Wharton St Pittsburgh PA 15203 Oral Surgeon Allegheny<br />
Kelly Derek Katsur <strong>Dental</strong> & Orthodontics Specialists 1955 Wharton St Pittsburgh PA 15203 Oral Surgeon Allegheny<br />
Kier Gregory Katsur <strong>Dental</strong> & Orthodontics Specialists 1955 Wharton St Pittsburgh PA 15203 Periodontist Allegheny<br />
Monti Richard Katsur <strong>Dental</strong> & Orthodontics Specialists 1955 Wharton St Pittsburgh PA 15203 Oral Surgeon Allegheny<br />
Dunn Stephen 000000001215 Southside <strong>Dental</strong> 1408 E Carson St. Pittsburgh PA 15203 General Provider Allegheny<br />
Aboosi Omar 000000033697 Aspen <strong>Dental</strong> Of Western Pa PC 5450 Campbells Run Rd. Pittsburgh PA 15205 General Provider Allegheny<br />
Grinberg Anna 000000033697 Aspen <strong>Dental</strong> Of Western Pa PC 5450 Campbells Run Rd. Pittsburgh PA 15205 General Provider Allegheny<br />
Owczarzak Timothy 000000033697 Aspen <strong>Dental</strong> Of Western Pa PC 5450 Campbells Run Rd. Pittsburgh PA 15205 General Provider Allegheny<br />
Wood Justin 000000033697 Aspen <strong>Dental</strong> Of Western Pa PC 5450 Campbells Run Rd. Pittsburgh PA 15205 General Provider Allegheny<br />
Lipp Timothy 000000001538 C. Timothy Lipp, D.M.D. 1 Robinson Plaza, Suite 160 Pittsburgh PA 15205 General Provider Allegheny<br />
Emmert Richard 000000001489 Emmert <strong>Dental</strong> Associates, P.C. 1730 Settlers Ridge Center Dr Pittsburgh PA 15205 General Provider Allegheny<br />
Bott Robert 000000001227 Robert P. Bott, D.M.D. 4245 Stuebenville Pk. Pittsburgh PA 15205 General Provider Allegheny<br />
Josephson Gerald 000000001542 Gerald M. Josephson, D.M.D. 5850 Centre Avenue Pittsburgh PA 15206 General Provider Allegheny<br />
* Hays Maria 000000001639 Kalson, Marcus, Hays & Associates, P.C. 579 Alger Street Pittsburgh PA 15207 General Provider Allegheny<br />
* Marcus Stanley 000000001639 Kalson, Marcus, Hays & Associates, P.C. 579 Alger Street Pittsburgh PA 15207 General Provider Allegheny<br />
Dunn Stephen 000000000993 Mount Oliver <strong>Dental</strong> Pavillion 145 Brownsville Road Pittsburgh PA 15210 General Provider Allegheny<br />
Rohm Constance 000000002185 Constance Rohm, D.M.D. 1850 Kleber Street Pittsburgh PA 15212 General Provider Allegheny<br />
Monda Thomas 000000001515 Thomas A. Monda, D.M.D. 1850 Kleber Street Pittsburgh PA 15212 General Provider Allegheny<br />
Aboosi Omar 000000002833 Aspen <strong>Dental</strong> Associates of Western PA PC 4815 Centre Ave., Suite 105 Pittsburgh PA 15213 General Provider Allegheny<br />
Bajaj Smriti 000000002833 Aspen <strong>Dental</strong> Associates of Western PA PC 4815 Centre Ave., Suite 105 Pittsburgh PA 15213 General Provider Allegheny<br />
Barber Timothy 000000002833 Aspen <strong>Dental</strong> Associates of Western PA PC 4815 Centre Ave., Suite 105 Pittsburgh PA 15213 General Provider Allegheny<br />
Bonczek Brian 000000002833 Aspen <strong>Dental</strong> Associates of Western PA PC 4815 Centre Ave., Suite 105 Pittsburgh PA 15213 General Provider Allegheny<br />
Budhiraj Anisha 000000002833 Aspen <strong>Dental</strong> Associates of Western PA PC 4815 Centre Ave., Suite 105 Pittsburgh PA 15213 General Provider Allegheny<br />
Ciarallo Robert Aspen <strong>Dental</strong> Associates of Western PA PC 4815 Centre Ave., Suite 105 Pittsburgh PA 15213 Oral Surgeon Allegheny<br />
Fnu Snigdha 000000002833 Aspen <strong>Dental</strong> Associates of Western PA PC 4815 Centre Ave., Suite 105 Pittsburgh PA 15213 General Provider Allegheny<br />
Ginde Mayura 000000002833 Aspen <strong>Dental</strong> Associates of Western PA PC 4815 Centre Ave., Suite 105 Pittsburgh PA 15213 General Provider Allegheny<br />
Grinberg Anna 000000002833 Aspen <strong>Dental</strong> Associates of Western PA PC 4815 Centre Ave., Suite 105 Pittsburgh PA 15213 General Provider Allegheny<br />
Khalil Mirette 000000002833 Aspen <strong>Dental</strong> Associates of Western PA PC 4815 Centre Ave., Suite 105 Pittsburgh PA 15213 General Provider Allegheny<br />
Liska Emily 000000002833 Aspen <strong>Dental</strong> Associates of Western PA PC 4815 Centre Ave., Suite 105 Pittsburgh PA 15213 General Provider Allegheny<br />
Masown Surinder 000000002833 Aspen <strong>Dental</strong> Associates of Western PA PC 4815 Centre Ave., Suite 105 Pittsburgh PA 15213 General Provider Allegheny<br />
Poleski Kenneth 000000002833 Aspen <strong>Dental</strong> Associates of Western PA PC 4815 Centre Ave., Suite 105 Pittsburgh PA 15213 General Provider Allegheny<br />
Ruprecht Heather 000000002833 Aspen <strong>Dental</strong> Associates of Western PA PC 4815 Centre Ave., Suite 105 Pittsburgh PA 15213 General Provider Allegheny<br />
Saba Christopher 000000002833 Aspen <strong>Dental</strong> Associates of Western PA PC 4815 Centre Ave., Suite 105 Pittsburgh PA 15213 General Provider Allegheny<br />
Smith Christine 000000002833 Aspen <strong>Dental</strong> Associates of Western PA PC 4815 Centre Ave., Suite 105 Pittsburgh PA 15213 General Provider Allegheny<br />
Wood Justin 000000002833 Aspen <strong>Dental</strong> Associates of Western PA PC 4815 Centre Ave., Suite 105 Pittsburgh PA 15213 General Provider Allegheny<br />
Jeffries Darlene 000000002217 Jeffries, Smith & Associates, P.C. 4929 Centre Avenue Pittsburgh PA 15213 General Provider Allegheny<br />
Parker Bruce 000000001619 Bruce Parker, D.M.D. 6301 Forbes Avenue, Suite 102 Pittsburgh PA 15217 General Provider Allegheny<br />
Runco Clinton 000000001217 Clinton W. Runco, D.M.D. 6300 Forward Ave. Pittsburgh PA 15217 General Provider Allegheny<br />
Dash Marvin Marvin A Dash DMD <strong>Inc</strong> 6301 Forbes Ave, Suite 230 Pittsburgh PA 15217 Oral Surgeon Allegheny<br />
Blinky David 000000001212 David G. Blinky, D.M.D., P.C. 7417 Irvine Ave. Pittsburgh PA 15218 General Provider Allegheny<br />
Demoise Michael 000000001212 David G. Blinky, D.M.D., P.C. 7417 Irvine Ave. Pittsburgh PA 15218 General Provider Allegheny<br />
Affolter John 000000002116 Katsur <strong>Dental</strong> & Orthodontics 1631 South Braddock Avenue Pittsburgh PA 15218 General Provider Allegheny<br />
Alagirisamy Kiruthika 000000033971 Katsur <strong>Dental</strong> & Orthodontics 1631 S Braddock Ave Pittsburgh PA 15218 General Provider Allegheny<br />
Carozza Roselyn 000000002116 Katsur <strong>Dental</strong> & Orthodontics 1631 South Braddock Avenue Pittsburgh PA 15218 General Provider Allegheny<br />
Cohen Ira 000000002116 Katsur <strong>Dental</strong> & Orthodontics 1631 South Braddock Avenue Pittsburgh PA 15218 General Provider Allegheny<br />
Dahar Nicholas Katsur <strong>Dental</strong> & Orthodontics 1631 S Braddock Ave Pittsburgh PA 15218 Orthodontist Allegheny<br />
Damich Louis 000000002116 Katsur <strong>Dental</strong> & Orthodontics 1631 South Braddock Avenue Pittsburgh PA 15218 General Provider Allegheny<br />
Dandashi Moutaz Katsur <strong>Dental</strong> & Orthodontics 1631 South Braddock Avenue Pittsburgh PA 15218 Pedodontist Allegheny<br />
Ghaffari Catherine 000000002116 Katsur <strong>Dental</strong> & Orthodontics 1631 South Braddock Avenue Pittsburgh PA 15218 General Provider Allegheny<br />
Ghajarnia M. Reza Katsur <strong>Dental</strong> & Orthodontics 1631 South Braddock Avenue Pittsburgh PA 15218 Orthodontist Allegheny<br />
Gillen Steve 000000002116 Katsur <strong>Dental</strong> & Orthodontics 1631 South Braddock Avenue Pittsburgh PA 15218 General Provider Allegheny<br />
Hertzler L Gregory Katsur <strong>Dental</strong> & Orthodontics 1631 South Braddock Avenue Pittsburgh PA 15218 Oral Surgeon Allegheny<br />
Iszkula Steven Katsur <strong>Dental</strong> & Orthodontics 1631 South Braddock Avenue Pittsburgh PA 15218 Orthodontist Allegheny<br />
Katsur James 000000002116 Katsur <strong>Dental</strong> & Orthodontics 1631 South Braddock Avenue Pittsburgh PA 15218 General Provider Allegheny<br />
Kelly Derek Katsur <strong>Dental</strong> & Orthodontics 1631 South Braddock Avenue Pittsburgh PA 15218 Oral Surgeon Allegheny<br />
Khurana Leena 000000002116 Katsur <strong>Dental</strong> & Orthodontics 1631 South Braddock Avenue Pittsburgh PA 15218 General Provider Allegheny<br />
Kier Calvin 000000002116 Katsur <strong>Dental</strong> & Orthodontics 1631 South Braddock Avenue Pittsburgh PA 15218 General Provider Allegheny<br />
Kier Gregory Katsur <strong>Dental</strong> & Orthodontics 1631 South Braddock Avenue Pittsburgh PA 15218 Periodontist Allegheny<br />
King David Katsur <strong>Dental</strong> & Orthodontics 1631 South Braddock Avenue Pittsburgh PA 15218 Orthodontist Allegheny<br />
* Indicates dentist that is accepting current patients only.<br />
All <strong>Select</strong> <strong>Plan</strong> <strong>Dentist</strong>s Page 13<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 <strong>Dentist</strong>. Fac ID is used to indicate which facility a member chooses.
SELECT PLAN 1 DENTIST DIRECTORY<br />
<strong>Dentist</strong>s listed are under contract as of 9/1/12<br />
Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />
Kolla Siva 000000033971 Katsur <strong>Dental</strong> & Orthodontics 1631 S Braddock Ave Pittsburgh PA 15218 General Provider Allegheny<br />
Lewis Howell Katsur <strong>Dental</strong> & Orthodontics 1631 South Braddock Avenue Pittsburgh PA 15218 Orthodontist Allegheny<br />
Miller Van Katsur <strong>Dental</strong> & Orthodontics 1631 South Braddock Avenue Pittsburgh PA 15218 Orthodontist Allegheny<br />
Monti Richard Katsur <strong>Dental</strong> & Orthodontics 1631 South Braddock Avenue Pittsburgh PA 15218 Oral Surgeon Allegheny<br />
Pryor Leroy 000000033971 Katsur <strong>Dental</strong> & Orthodontics 1631 S Braddock Ave Pittsburgh PA 15218 General Provider Allegheny<br />
Pryor Leroy 000000002116 Katsur <strong>Dental</strong> & Orthodontics 1631 South Braddock Avenue Pittsburgh PA 15218 General Provider Allegheny<br />
Rinchuse Dara Katsur <strong>Dental</strong> & Orthodontics 1631 South Braddock Avenue Pittsburgh PA 15218 Orthodontist Allegheny<br />
Schmidt Alan 000000002116 Katsur <strong>Dental</strong> & Orthodontics 1631 South Braddock Avenue Pittsburgh PA 15218 General Provider Allegheny<br />
Smiga Ingrid 000000002116 Katsur <strong>Dental</strong> & Orthodontics 1631 South Braddock Avenue Pittsburgh PA 15218 General Provider Allegheny<br />
Stein Mark 000000033971 Katsur <strong>Dental</strong> & Orthodontics 1631 S Braddock Ave Pittsburgh PA 15218 General Provider Allegheny<br />
Tinnemeyer Anjuli 000000002116 Katsur <strong>Dental</strong> & Orthodontics 1631 South Braddock Avenue Pittsburgh PA 15218 General Provider Allegheny<br />
Zalakar Frank 000000002116 Katsur <strong>Dental</strong> & Orthodontics 1631 South Braddock Avenue Pittsburgh PA 15218 General Provider Allegheny<br />
Certo Joseph 000000001225 Joseph S. Certo DMD, LLC 1350 Locust St, 307 Pittsburgh PA 15219 General Provider Allegheny<br />
* Hays Maria 000000001638 Marcus, Hays & Associates, P.C. Chatham Tower, Suite 1-D Pittsburgh PA 15219 General Provider Allegheny<br />
* Marcus Stanley 000000001638 Marcus, Hays & Associates, P.C. Chatham Tower, Suite 1-D Pittsburgh PA 15219 General Provider Allegheny<br />
Palmer Mark 000000001572 Palmer Family <strong>Dentist</strong>ry 1910 Cochran Road Pittsburgh PA 15220 General Provider Allegheny<br />
Snow Russell 000000035090 Russell B Snow DMD 21 Yost Boulevard, Suite 201 Pittsburgh PA 15221 General Provider Allegheny<br />
Emmert Richard 000000001488 Emmert <strong>Dental</strong> Associates, P.C. 433 Market Square Pittsburgh PA 15222 General Provider Allegheny<br />
Dash Marvin Marvin A Dash DMD <strong>Inc</strong> 355 5th Ave Park Bldg, Suite 1306 Pittsburgh PA 15222 Oral Surgeon Allegheny<br />
King Spencer 000000001213 Spencer T. King, D.D.S. & Associates 239 Fourth Ave, Suite 403 Pittsburgh PA 15222 General Provider Allegheny<br />
Aboosi Omar 000000002659 Aspen <strong>Dental</strong> Associates of Western PA PC 306 Towne Square Way Pittsburgh PA 15227 General Provider Allegheny<br />
Bajaj Smriti 000000002659 Aspen <strong>Dental</strong> Associates of Western PA PC 306 Towne Square Way Pittsburgh PA 15227 General Provider Allegheny<br />
Barber Timothy 000000002659 Aspen <strong>Dental</strong> Associates of Western PA PC 306 Towne Square Way Pittsburgh PA 15227 General Provider Allegheny<br />
Bonczek Brian 000000002659 Aspen <strong>Dental</strong> Associates of Western PA PC 306 Towne Square Way Pittsburgh PA 15227 General Provider Allegheny<br />
Budhiraj Anisha 000000002659 Aspen <strong>Dental</strong> Associates of Western PA PC 306 Towne Square Way Pittsburgh PA 15227 General Provider Allegheny<br />
Ciarallo Robert Aspen <strong>Dental</strong> Associates of Western PA PC 306 Towne Square Way Pittsburgh PA 15227 Oral Surgeon Allegheny<br />
Fnu Snigdha 000000002659 Aspen <strong>Dental</strong> Associates of Western PA PC 306 Towne Square Way Pittsburgh PA 15227 General Provider Allegheny<br />
Ginde Mayura 000000002659 Aspen <strong>Dental</strong> Associates of Western PA PC 306 Towne Square Way Pittsburgh PA 15227 General Provider Allegheny<br />
Grinberg Anna 000000002659 Aspen <strong>Dental</strong> Associates of Western PA PC 306 Towne Square Way Pittsburgh PA 15227 General Provider Allegheny<br />
Hamati Isam 000000002659 Aspen <strong>Dental</strong> Associates of Western PA PC 306 Towne Square Way Pittsburgh PA 15227 General Provider Allegheny<br />
Khalil Mirette 000000002659 Aspen <strong>Dental</strong> Associates of Western PA PC 306 Towne Square Way Pittsburgh PA 15227 General Provider Allegheny<br />
Liska Emily 000000002659 Aspen <strong>Dental</strong> Associates of Western PA PC 306 Towne Square Way Pittsburgh PA 15227 General Provider Allegheny<br />
Masown Surinder 000000002659 Aspen <strong>Dental</strong> Associates of Western PA PC 306 Towne Square Way Pittsburgh PA 15227 General Provider Allegheny<br />
Poleski Kenneth 000000002659 Aspen <strong>Dental</strong> Associates of Western PA PC 306 Towne Square Way Pittsburgh PA 15227 General Provider Allegheny<br />
Ruprecht Heather 000000002659 Aspen <strong>Dental</strong> Associates of Western PA PC 306 Towne Square Way Pittsburgh PA 15227 General Provider Allegheny<br />
Saba Christopher 000000002659 Aspen <strong>Dental</strong> Associates of Western PA PC 306 Towne Square Way Pittsburgh PA 15227 General Provider Allegheny<br />
Smith Christine 000000002659 Aspen <strong>Dental</strong> Associates of Western PA PC 306 Towne Square Way Pittsburgh PA 15227 General Provider Allegheny<br />
Wood Justin 000000002659 Aspen <strong>Dental</strong> Associates of Western PA PC 306 Towne Square Way Pittsburgh PA 15227 General Provider Allegheny<br />
Gans Michael 000000001490 Michael J. Gans, D.M.D. 1699 Washington Road Pittsburgh PA 15228 General Provider Allegheny<br />
Pasqual Harry Pasqual Associates 603 Washington Rd. Pittsburgh PA 15228 Oral Surgeon Allegheny<br />
Sassouni Anouk Sassouni Orthodontics 607 Washington Road Pittsburgh PA 15228 Orthodontist Allegheny<br />
Cohen Bruce 000000001211 Family <strong>Dental</strong> Care 344 Center Ave., West View Pittsburgh PA 15229 General Provider Allegheny<br />
Adams William 000000001076 Katsur <strong>Dental</strong> & Orthodontics 1004 West View Park Dr. Pittsburgh PA 15229 General Provider Allegheny<br />
Affolter John 000000001076 Katsur <strong>Dental</strong> & Orthodontics 1004 West View Park Dr. Pittsburgh PA 15229 General Provider Allegheny<br />
Alagirisamy Kiruthika 000000001076 Katsur <strong>Dental</strong> & Orthodontics 1004 West View Park Dr. Pittsburgh PA 15229 General Provider Allegheny<br />
Carozza Roselyn 000000001076 Katsur <strong>Dental</strong> & Orthodontics 1004 West View Park Dr. Pittsburgh PA 15229 General Provider Allegheny<br />
Cohen Ira 000000001076 Katsur <strong>Dental</strong> & Orthodontics 1004 West View Park Dr. Pittsburgh PA 15229 General Provider Allegheny<br />
Dahar Nicholas Katsur <strong>Dental</strong> & Orthodontics 1004 West View Park Dr. Pittsburgh PA 15229 Orthodontist Allegheny<br />
Damich Louis 000000001076 Katsur <strong>Dental</strong> & Orthodontics 1004 West View Park Dr. Pittsburgh PA 15229 General Provider Allegheny<br />
Ghaffari Catherine 000000001076 Katsur <strong>Dental</strong> & Orthodontics 1004 West View Park Dr. Pittsburgh PA 15229 General Provider Allegheny<br />
Ghajarnia M. Reza Katsur <strong>Dental</strong> & Orthodontics 1004 West View Park Dr. Pittsburgh PA 15229 Orthodontist Allegheny<br />
Gillen Steve 000000001076 Katsur <strong>Dental</strong> & Orthodontics 1004 West View Park Dr. Pittsburgh PA 15229 General Provider Allegheny<br />
Iszkula Steven Katsur <strong>Dental</strong> & Orthodontics 1004 West View Park Dr. Pittsburgh PA 15229 Orthodontist Allegheny<br />
Katsur James 000000001076 Katsur <strong>Dental</strong> & Orthodontics 1004 West View Park Dr. Pittsburgh PA 15229 General Provider Allegheny<br />
Khurana Leena 000000001076 Katsur <strong>Dental</strong> & Orthodontics 1004 West View Park Dr. Pittsburgh PA 15229 General Provider Allegheny<br />
Kier Calvin 000000001076 Katsur <strong>Dental</strong> & Orthodontics 1004 West View Park Dr. Pittsburgh PA 15229 General Provider Allegheny<br />
King David Katsur <strong>Dental</strong> & Orthodontics 1004 West View Park Dr. Pittsburgh PA 15229 Orthodontist Allegheny<br />
Kolla Siva 000000001076 Katsur <strong>Dental</strong> & Orthodontics 1004 West View Park Dr. Pittsburgh PA 15229 General Provider Allegheny<br />
Lewis Howell Katsur <strong>Dental</strong> & Orthodontics 1004 West View Park Dr. Pittsburgh PA 15229 Orthodontist Allegheny<br />
Miller Van Katsur <strong>Dental</strong> & Orthodontics 1004 West View Park Dr. Pittsburgh PA 15229 Orthodontist Allegheny<br />
Pryor Leroy 000000001076 Katsur <strong>Dental</strong> & Orthodontics 1004 West View Park Dr. Pittsburgh PA 15229 General Provider Allegheny<br />
Rinchuse Dara Katsur <strong>Dental</strong> & Orthodontics 1004 West View Park Dr. Pittsburgh PA 15229 Orthodontist Allegheny<br />
Schmidt Alan 000000001076 Katsur <strong>Dental</strong> & Orthodontics 1004 West View Park Dr. Pittsburgh PA 15229 General Provider Allegheny<br />
Smiga Ingrid 000000001076 Katsur <strong>Dental</strong> & Orthodontics 1004 West View Park Dr. Pittsburgh PA 15229 General Provider Allegheny<br />
Stein Mark 000000001076 Katsur <strong>Dental</strong> & Orthodontics 1004 West View Park Dr. Pittsburgh PA 15229 General Provider Allegheny<br />
Tinnemeyer Anjuli 000000001076 Katsur <strong>Dental</strong> & Orthodontics 1004 West View Park Dr. Pittsburgh PA 15229 General Provider Allegheny<br />
* Indicates dentist that is accepting current patients only.<br />
All <strong>Select</strong> <strong>Plan</strong> <strong>Dentist</strong>s Page 14<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 <strong>Dentist</strong>. Fac ID is used to indicate which facility a member chooses.
SELECT PLAN 1 DENTIST DIRECTORY<br />
<strong>Dentist</strong>s listed are under contract as of 9/1/12<br />
Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />
Zalakar Frank 000000001076 Katsur <strong>Dental</strong> & Orthodontics 1004 West View Park Dr. Pittsburgh PA 15229 General Provider Allegheny<br />
Dandashi Moutaz Katsur <strong>Dental</strong> & Orthodontics Specialists 1004 W View Park Dr Pittsburgh PA 15229 Pedodontist Allegheny<br />
Hertzler L Gregory Katsur <strong>Dental</strong> & Orthodontics Specialists 1004 W View Park Dr Pittsburgh PA 15229 Oral Surgeon Allegheny<br />
Kelly Derek Katsur <strong>Dental</strong> & Orthodontics Specialists 1004 W View Park Dr Pittsburgh PA 15229 Oral Surgeon Allegheny<br />
Kier Gregory Katsur <strong>Dental</strong> & Orthodontics Specialists 1004 W View Park Dr Pittsburgh PA 15229 Periodontist Allegheny<br />
Monti Richard Katsur <strong>Dental</strong> & Orthodontics Specialists 1004 W View Park Dr Pittsburgh PA 15229 Oral Surgeon Allegheny<br />
Check Jennifer 000000061366 Aspen <strong>Dental</strong> 3459 William Penn Hwy Pittsburgh PA 15235 General Provider Allegheny<br />
Ciarallo Robert Aspen <strong>Dental</strong> 3459 William Penn Hwy Pittsburgh PA 15235 Oral Surgeon Allegheny<br />
Cignetti Scott 000000061366 Aspen <strong>Dental</strong> 3459 William Penn Hwy Pittsburgh PA 15235 General Provider Allegheny<br />
Fazio John 000000061366 Aspen <strong>Dental</strong> 3459 William Penn Hwy Pittsburgh PA 15235 General Provider Allegheny<br />
Ferguson III William 000000061366 Aspen <strong>Dental</strong> 3459 William Penn Hwy Pittsburgh PA 15235 General Provider Allegheny<br />
Grinberg Anna 000000061366 Aspen <strong>Dental</strong> 3459 William Penn Hwy Pittsburgh PA 15235 General Provider Allegheny<br />
Malone Matthew 000000061366 Aspen <strong>Dental</strong> 3459 William Penn Hwy Pittsburgh PA 15235 General Provider Allegheny<br />
McCann Eve 000000061366 Aspen <strong>Dental</strong> 3459 William Penn Hwy Pittsburgh PA 15235 General Provider Allegheny<br />
McClain Kelly 000000061366 Aspen <strong>Dental</strong> 3459 William Penn Hwy Pittsburgh PA 15235 General Provider Allegheny<br />
Monios George 000000061366 Aspen <strong>Dental</strong> 3459 William Penn Hwy Pittsburgh PA 15235 General Provider Allegheny<br />
Raja Nabila 000000061366 Aspen <strong>Dental</strong> 3459 William Penn Hwy Pittsburgh PA 15235 General Provider Allegheny<br />
Somers Mitchell 000000061366 Aspen <strong>Dental</strong> 3459 William Penn Hwy Pittsburgh PA 15235 General Provider Allegheny<br />
Tam Dominic 000000061366 Aspen <strong>Dental</strong> 3459 William Penn Hwy Pittsburgh PA 15235 General Provider Allegheny<br />
Trichtinger John 000000001226 Trichtinger <strong>Dental</strong>, P.C. 11979 Frankstown Rd. Pittsburgh PA 15235 General Provider Allegheny<br />
Aboosi Omar 000000050445 Aspen <strong>Dental</strong> Associates of Western PA PC 560 Clariton Blvd, Suite 1 Pittsburgh PA 15236 General Provider Allegheny<br />
Bajaj Smriti 000000050445 Aspen <strong>Dental</strong> Associates of Western PA PC 560 Clariton Blvd, Suite 1 Pittsburgh PA 15236 General Provider Allegheny<br />
Barber Timothy 000000050445 Aspen <strong>Dental</strong> Associates of Western PA PC 560 Clariton Blvd, Suite 1 Pittsburgh PA 15236 General Provider Allegheny<br />
Bonczek Brian 000000050445 Aspen <strong>Dental</strong> Associates of Western PA PC 560 Clariton Blvd, Suite 1 Pittsburgh PA 15236 General Provider Allegheny<br />
Budhiraj Anisha 000000050445 Aspen <strong>Dental</strong> Associates of Western PA PC 560 Clariton Blvd, Suite 1 Pittsburgh PA 15236 General Provider Allegheny<br />
Ciarallo Robert Aspen <strong>Dental</strong> Associates of Western PA PC 560 Clariton Blvd, Suite 1 Pittsburgh PA 15236 Oral Surgeon Allegheny<br />
Fnu Snigdha 000000050445 Aspen <strong>Dental</strong> Associates of Western PA PC 560 Clariton Blvd, Suite 1 Pittsburgh PA 15236 General Provider Allegheny<br />
Ginde Mayura 000000050445 Aspen <strong>Dental</strong> Associates of Western PA PC 560 Clariton Blvd, Suite 1 Pittsburgh PA 15236 General Provider Allegheny<br />
Grinberg Anna 000000050445 Aspen <strong>Dental</strong> Associates of Western PA PC 560 Clariton Blvd, Suite 1 Pittsburgh PA 15236 General Provider Allegheny<br />
Khalil Mirette 000000050445 Aspen <strong>Dental</strong> Associates of Western PA PC 560 Clariton Blvd, Suite 1 Pittsburgh PA 15236 General Provider Allegheny<br />
Liska Emily 000000050445 Aspen <strong>Dental</strong> Associates of Western PA PC 560 Clariton Blvd, Suite 1 Pittsburgh PA 15236 General Provider Allegheny<br />
Masown Surinder 000000050445 Aspen <strong>Dental</strong> Associates of Western PA PC 560 Clariton Blvd, Suite 1 Pittsburgh PA 15236 General Provider Allegheny<br />
Poleski Kenneth 000000050445 Aspen <strong>Dental</strong> Associates of Western PA PC 560 Clariton Blvd, Suite 1 Pittsburgh PA 15236 General Provider Allegheny<br />
Ruprecht Heather 000000050445 Aspen <strong>Dental</strong> Associates of Western PA PC 560 Clariton Blvd, Suite 1 Pittsburgh PA 15236 General Provider Allegheny<br />
Saba Christopher 000000050445 Aspen <strong>Dental</strong> Associates of Western PA PC 560 Clariton Blvd, Suite 1 Pittsburgh PA 15236 General Provider Allegheny<br />
Smith Christine 000000050445 Aspen <strong>Dental</strong> Associates of Western PA PC 560 Clariton Blvd, Suite 1 Pittsburgh PA 15236 General Provider Allegheny<br />
Wood Justin 000000050445 Aspen <strong>Dental</strong> Associates of Western PA PC 560 Clariton Blvd, Suite 1 Pittsburgh PA 15236 General Provider Allegheny<br />
Zora James 000000001583 Jame R Zora DMD 555 E Bruceton Rd. Pittsburgh PA 15236 General Provider Allegheny<br />
Adams William 000000001080 Katsur <strong>Dental</strong> & Orthodontics 2A Old Clairton Road Pittsburgh PA 15236 General Provider Allegheny<br />
Affolter John 000000001080 Katsur <strong>Dental</strong> & Orthodontics 2A Old Clairton Road Pittsburgh PA 15236 General Provider Allegheny<br />
Alagirisamy Kiruthika 000000001080 Katsur <strong>Dental</strong> & Orthodontics 2A Old Clairton Road Pittsburgh PA 15236 General Provider Allegheny<br />
Carozza Roselyn 000000001080 Katsur <strong>Dental</strong> & Orthodontics 2A Old Clairton Road Pittsburgh PA 15236 General Provider Allegheny<br />
Cohen Ira 000000001080 Katsur <strong>Dental</strong> & Orthodontics 2A Old Clairton Road Pittsburgh PA 15236 General Provider Allegheny<br />
Dahar Nicholas Katsur <strong>Dental</strong> & Orthodontics 2A Old Clairton Road Pittsburgh PA 15236 Orthodontist Allegheny<br />
Damich Louis 000000001080 Katsur <strong>Dental</strong> & Orthodontics 2A Old Clairton Road Pittsburgh PA 15236 General Provider Allegheny<br />
Ghaffari Catherine 000000001080 Katsur <strong>Dental</strong> & Orthodontics 2A Old Clairton Road Pittsburgh PA 15236 General Provider Allegheny<br />
Ghajarnia M. Reza Katsur <strong>Dental</strong> & Orthodontics 2A Old Clairton Road Pittsburgh PA 15236 Orthodontist Allegheny<br />
Gillen Steve 000000001080 Katsur <strong>Dental</strong> & Orthodontics 2A Old Clairton Road Pittsburgh PA 15236 General Provider Allegheny<br />
Iszkula Steven Katsur <strong>Dental</strong> & Orthodontics 2A Old Clairton Road Pittsburgh PA 15236 Orthodontist Allegheny<br />
Katsur James 000000001080 Katsur <strong>Dental</strong> & Orthodontics 2A Old Clairton Road Pittsburgh PA 15236 General Provider Allegheny<br />
Khurana Leena 000000001080 Katsur <strong>Dental</strong> & Orthodontics 2A Old Clairton Road Pittsburgh PA 15236 General Provider Allegheny<br />
Kier Calvin 000000001080 Katsur <strong>Dental</strong> & Orthodontics 2A Old Clairton Road Pittsburgh PA 15236 General Provider Allegheny<br />
King David Katsur <strong>Dental</strong> & Orthodontics 2A Old Clairton Road Pittsburgh PA 15236 Orthodontist Allegheny<br />
Kolla Siva 000000001080 Katsur <strong>Dental</strong> & Orthodontics 2A Old Clairton Road Pittsburgh PA 15236 General Provider Allegheny<br />
Lewis Howell Katsur <strong>Dental</strong> & Orthodontics 2A Old Clairton Road Pittsburgh PA 15236 Orthodontist Allegheny<br />
Miller Van Katsur <strong>Dental</strong> & Orthodontics 2A Old Clairton Road Pittsburgh PA 15236 Orthodontist Allegheny<br />
Pryor Leroy 000000001080 Katsur <strong>Dental</strong> & Orthodontics 2A Old Clairton Road Pittsburgh PA 15236 General Provider Allegheny<br />
Rinchuse Dara Katsur <strong>Dental</strong> & Orthodontics 2A Old Clairton Road Pittsburgh PA 15236 Orthodontist Allegheny<br />
Schmidt Alan 000000001080 Katsur <strong>Dental</strong> & Orthodontics 2A Old Clairton Road Pittsburgh PA 15236 General Provider Allegheny<br />
Smiga Ingrid 000000001080 Katsur <strong>Dental</strong> & Orthodontics 2A Old Clairton Road Pittsburgh PA 15236 General Provider Allegheny<br />
Stein Mark 000000001080 Katsur <strong>Dental</strong> & Orthodontics 2A Old Clairton Road Pittsburgh PA 15236 General Provider Allegheny<br />
Tinnemeyer Anjuli 000000001080 Katsur <strong>Dental</strong> & Orthodontics 2A Old Clairton Road Pittsburgh PA 15236 General Provider Allegheny<br />
Zalakar Frank 000000001080 Katsur <strong>Dental</strong> & Orthodontics 2A Old Clairton Road Pittsburgh PA 15236 General Provider Allegheny<br />
Dandashi Moutaz Katsur <strong>Dental</strong> & Orthodontics Specialists 2A Old Clariton Rd Pittsburgh PA 15236 Pedodontist Allegheny<br />
Hertzler L Gregory Katsur <strong>Dental</strong> & Orthodontics Specialists 2A Old Clariton Rd Pittsburgh PA 15236 Oral Surgeon Allegheny<br />
Kelly Derek Katsur <strong>Dental</strong> & Orthodontics Specialists 2A Old Clariton Rd Pittsburgh PA 15236 Oral Surgeon Allegheny<br />
* Indicates dentist that is accepting current patients only.<br />
All <strong>Select</strong> <strong>Plan</strong> <strong>Dentist</strong>s Page 15<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 <strong>Dentist</strong>. Fac ID is used to indicate which facility a member chooses.
SELECT PLAN 1 DENTIST DIRECTORY<br />
<strong>Dentist</strong>s listed are under contract as of 9/1/12<br />
Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />
Kier Gregory Katsur <strong>Dental</strong> & Orthodontics Specialists 2A Old Clariton Rd Pittsburgh PA 15236 Periodontist Allegheny<br />
Monti Richard Katsur <strong>Dental</strong> & Orthodontics Specialists 2A Old Clariton Rd Pittsburgh PA 15236 Oral Surgeon Allegheny<br />
Smiga Steven 000000001235 Steven I. Smiga, D.M.D. 4730 Clairton Blvd. Pittsburgh PA 15236 General Provider Allegheny<br />
Aboosi Omar 000000002884 Aspen <strong>Dental</strong> Associates of NY, PC 7372 B. McKnight Road Pittsburgh PA 15237 General Provider Allegheny<br />
Grinberg Anna 000000002884 Aspen <strong>Dental</strong> Associates of NY, PC 7372 B. McKnight Road Pittsburgh PA 15237 General Provider Allegheny<br />
Owczarzak Timothy 000000002884 Aspen <strong>Dental</strong> Associates of NY, PC 7372 B. McKnight Road Pittsburgh PA 15237 General Provider Allegheny<br />
Wood Justin 000000002884 Aspen <strong>Dental</strong> Associates of NY, PC 7372 B. McKnight Road Pittsburgh PA 15237 General Provider Allegheny<br />
Herock Michael 000000000486 Certus <strong>Dental</strong>Care, LLC 8035 McKnight Road, Ste 201, Andre Plaza Pittsburgh PA 15237 General Provider Allegheny<br />
Mikus Mark 000000001879 Mark A. Mikus Family <strong>Dentist</strong>ry 9400 McKnight Rd., Suite 101 Pittsburgh PA 15237 General Provider Allegheny<br />
Miller Richard 000000001241 Richard Miller, D.M.D. 449 Rochester Rd. Pittsburgh PA 15237 General Provider Allegheny<br />
Conquest Matthew Snyder & Dugan Oral & Maxillofacial Surgery 9401 McKnight Rd, Suite 201 Pittsburgh PA 15237 Oral Surgeon Allegheny<br />
Dugan Michael Snyder & Dugan Oral & Maxillofacial Surgery 9401 McKnight Rd, Suite 201 Pittsburgh PA 15237 Oral Surgeon Allegheny<br />
Snyder Richard Snyder & Dugan Oral & Maxillofacial Surgery 9401 McKnight Rd, Suite 201 Pittsburgh PA 15237 Oral Surgeon Allegheny<br />
Sweeney Patrick Snyder & Dugan Oral & Maxillofacial Surgery 9401 McKnight Rd, Suite 201 Pittsburgh PA 15237 Oral Surgeon Allegheny<br />
Toth Thomas 000000001437 Thomas M. Toth, D.M.D. 100 McKnight Park Drive, Suite 102 Pittsburgh PA 15237 General Provider Allegheny<br />
Sante Richard 000000001498 Richard A. Sante, Jr., D.M.D. 8075 Saltsburg Rd. Pittsburgh PA 15239 General Provider Allegheny<br />
Oakley Marnie 000000001429 University of Pittsburgh School of <strong>Dental</strong> Medicine 3501 Terrace Street, Salk Hall Pittsburgh PA 15261 General Provider Allegheny<br />
Schnieder Lawrence 000000001429 University of Pittsburgh School of <strong>Dental</strong> Medicine 3501 Terrace Street, Salk Hall Pittsburgh PA 15261 General Provider Allegheny<br />
Ciarallo Robert Aspen <strong>Dental</strong> of Western PA, PC 2031 Pittsburgh Mills Blvd. Tarentum PA 15084 Oral Surgeon Allegheny<br />
Garver Eric 000000033835 Aspen <strong>Dental</strong> of Western PA, PC 2031 Pittsburgh Mills Blvd. Tarentum PA 15084 General Provider Allegheny<br />
Grinberg Anna 000000033835 Aspen <strong>Dental</strong> of Western PA, PC 2031 Pittsburgh Mills Blvd. Tarentum PA 15084 General Provider Allegheny<br />
Laughrey Nathan 000000033835 Aspen <strong>Dental</strong> of Western PA, PC 2031 Pittsburgh Mills Blvd. Tarentum PA 15084 General Provider Allegheny<br />
Ruprecht Heather 000000033835 Aspen <strong>Dental</strong> of Western PA, PC 2031 Pittsburgh Mills Blvd. Tarentum PA 15084 General Provider Allegheny<br />
Manalo Arsenio 000000001210 Manalo <strong>Dental</strong> & Associates Duquesne Village, 1870 B Homeville Road West Mifflin PA 15122 General Provider Allegheny<br />
Grady John John Marshall Grady DMD Associates LLC 1000 Brooktree Road, Suite 200 Wexford PA 15090 Orthodontist Allegheny<br />
Kastner Dan John Marshall Grady DMD Associates LLC 1000 Brooktree Road, Suite 200 Wexford PA 15090 Orthodontist Allegheny<br />
Nadarajah Jodi 000000001271 Beaver Valley <strong>Dental</strong> 546 Merchant St. Ambridge PA 15003 General Provider Beaver<br />
Lipp Timothy 000000001352 C. Timothy Lipp, D.M.D. 3315 4th Avenue Beaver Falls PA 15010 General Provider Beaver<br />
DiPaul Eric 000000001612 Primary Health Network/Beaver Falls <strong>Dental</strong> Center 1302 7th Ave Beaver Falls PA 15010 General Provider Beaver<br />
Lipscomb Richard 000000001612 Primary Health Network/Beaver Falls <strong>Dental</strong> Center 1302 7th Ave Beaver Falls PA 15010 General Provider Beaver<br />
Aboosi Omar 000000002859 Aspen <strong>Dental</strong> Associates of Western PA PC 190 Golfview Drive, Centerpoint Shopping Ctr. Monaca PA 15061 General Provider Beaver<br />
Bajaj Smriti 000000002859 Aspen <strong>Dental</strong> Associates of Western PA PC 190 Golfview Drive, Centerpoint Shopping Ctr. Monaca PA 15061 General Provider Beaver<br />
Barber Timothy 000000002859 Aspen <strong>Dental</strong> Associates of Western PA PC 190 Golfview Drive, Centerpoint Shopping Ctr. Monaca PA 15061 General Provider Beaver<br />
Bonczek Brian 000000002859 Aspen <strong>Dental</strong> Associates of Western PA PC 190 Golfview Drive, Centerpoint Shopping Ctr. Monaca PA 15061 General Provider Beaver<br />
Budhiraj Anisha 000000002859 Aspen <strong>Dental</strong> Associates of Western PA PC 190 Golfview Drive, Centerpoint Shopping Ctr. Monaca PA 15061 General Provider Beaver<br />
Cahall Anna 000000002859 Aspen <strong>Dental</strong> Associates of Western PA PC 190 Golfview Drive, Centerpoint Shopping Ctr. Monaca PA 15061 General Provider Beaver<br />
Ciarallo Robert Aspen <strong>Dental</strong> Associates of Western PA PC 190 Golfview Drive, Centerpoint Shopping Ctr. Monaca PA 15061 Oral Surgeon Beaver<br />
Fnu Snigdha 000000002859 Aspen <strong>Dental</strong> Associates of Western PA PC 190 Golfview Drive, Centerpoint Shopping Ctr. Monaca PA 15061 General Provider Beaver<br />
Ginde Mayura 000000002859 Aspen <strong>Dental</strong> Associates of Western PA PC 190 Golfview Drive, Centerpoint Shopping Ctr. Monaca PA 15061 General Provider Beaver<br />
Grinberg Anna 000000002859 Aspen <strong>Dental</strong> Associates of Western PA PC 190 Golfview Drive, Centerpoint Shopping Ctr. Monaca PA 15061 General Provider Beaver<br />
Khalil Mirette 000000002859 Aspen <strong>Dental</strong> Associates of Western PA PC 190 Golfview Drive, Centerpoint Shopping Ctr. Monaca PA 15061 General Provider Beaver<br />
Liska Emily 000000002859 Aspen <strong>Dental</strong> Associates of Western PA PC 190 Golfview Drive, Centerpoint Shopping Ctr. Monaca PA 15061 General Provider Beaver<br />
Masown Surinder 000000002859 Aspen <strong>Dental</strong> Associates of Western PA PC 190 Golfview Drive, Centerpoint Shopping Ctr. Monaca PA 15061 General Provider Beaver<br />
Poleski Kenneth 000000002859 Aspen <strong>Dental</strong> Associates of Western PA PC 190 Golfview Drive, Centerpoint Shopping Ctr. Monaca PA 15061 General Provider Beaver<br />
Ruprecht Heather 000000002859 Aspen <strong>Dental</strong> Associates of Western PA PC 190 Golfview Drive, Centerpoint Shopping Ctr. Monaca PA 15061 General Provider Beaver<br />
Saba Christopher 000000002859 Aspen <strong>Dental</strong> Associates of Western PA PC 190 Golfview Drive, Centerpoint Shopping Ctr. Monaca PA 15061 General Provider Beaver<br />
Smith Christine 000000002859 Aspen <strong>Dental</strong> Associates of Western PA PC 190 Golfview Drive, Centerpoint Shopping Ctr. Monaca PA 15061 General Provider Beaver<br />
Wood Justin 000000002859 Aspen <strong>Dental</strong> Associates of Western PA PC 190 Golfview Drive, Centerpoint Shopping Ctr. Monaca PA 15061 General Provider Beaver<br />
Skoff David 000000001433 David M. Skoff, D.M.D., P.C. 3532 Brodhead Road Monaca PA 15061 General Provider Beaver<br />
Skoff Joseph 000000001433 David M. Skoff, D.M.D., P.C. 3532 Brodhead Road Monaca PA 15061 General Provider Beaver<br />
Adams William 000000001075 Katsur <strong>Dental</strong> & Orthodontics 7A Wal-Mart Plaza, Rte.18 Monaca PA 15061 General Provider Beaver<br />
Affolter John 000000001075 Katsur <strong>Dental</strong> & Orthodontics 7A Wal-Mart Plaza, Rte.18 Monaca PA 15061 General Provider Beaver<br />
Alagirisamy Kiruthika 000000001075 Katsur <strong>Dental</strong> & Orthodontics 7A Wal-Mart Plaza, Rte.18 Monaca PA 15061 General Provider Beaver<br />
Carozza Roselyn 000000001075 Katsur <strong>Dental</strong> & Orthodontics 7A Wal-Mart Plaza, Rte.18 Monaca PA 15061 General Provider Beaver<br />
Cohen Ira 000000001075 Katsur <strong>Dental</strong> & Orthodontics 7A Wal-Mart Plaza, Rte.18 Monaca PA 15061 General Provider Beaver<br />
Dahar Nicholas Katsur <strong>Dental</strong> & Orthodontics 7A Wal-Mart Plaza, Rte.18 Monaca PA 15061 Orthodontist Beaver<br />
Damich Louis 000000001075 Katsur <strong>Dental</strong> & Orthodontics 7A Wal-Mart Plaza, Rte.18 Monaca PA 15061 General Provider Beaver<br />
Ghaffari Catherine 000000001075 Katsur <strong>Dental</strong> & Orthodontics 7A Wal-Mart Plaza, Rte.18 Monaca PA 15061 General Provider Beaver<br />
Ghajarnia M. Reza Katsur <strong>Dental</strong> & Orthodontics 7A Wal-Mart Plaza, Rte.18 Monaca PA 15061 Orthodontist Beaver<br />
Gillen Steve 000000001075 Katsur <strong>Dental</strong> & Orthodontics 7A Wal-Mart Plaza, Rte.18 Monaca PA 15061 General Provider Beaver<br />
Iszkula Steven Katsur <strong>Dental</strong> & Orthodontics 7A Wal-Mart Plaza, Rte.18 Monaca PA 15061 Orthodontist Beaver<br />
Katsur James 000000001075 Katsur <strong>Dental</strong> & Orthodontics 7A Wal-Mart Plaza, Rte.18 Monaca PA 15061 General Provider Beaver<br />
Khurana Leena 000000001075 Katsur <strong>Dental</strong> & Orthodontics 7A Wal-Mart Plaza, Rte.18 Monaca PA 15061 General Provider Beaver<br />
Kier Calvin 000000001075 Katsur <strong>Dental</strong> & Orthodontics 7A Wal-Mart Plaza, Rte.18 Monaca PA 15061 General Provider Beaver<br />
King David Katsur <strong>Dental</strong> & Orthodontics 7A Wal-Mart Plaza, Rte.18 Monaca PA 15061 Orthodontist Beaver<br />
Kolla Siva 000000001075 Katsur <strong>Dental</strong> & Orthodontics 7A Wal-Mart Plaza, Rte.18 Monaca PA 15061 General Provider Beaver<br />
* Indicates dentist that is accepting current patients only.<br />
All <strong>Select</strong> <strong>Plan</strong> <strong>Dentist</strong>s Page 16<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 <strong>Dentist</strong>. Fac ID is used to indicate which facility a member chooses.
SELECT PLAN 1 DENTIST DIRECTORY<br />
<strong>Dentist</strong>s listed are under contract as of 9/1/12<br />
Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />
Lewis Howell Katsur <strong>Dental</strong> & Orthodontics 7A Wal-Mart Plaza, Rte.18 Monaca PA 15061 Orthodontist Beaver<br />
Miller Van Katsur <strong>Dental</strong> & Orthodontics 7A Wal-Mart Plaza, Rte.18 Monaca PA 15061 Orthodontist Beaver<br />
Pryor Leroy 000000001075 Katsur <strong>Dental</strong> & Orthodontics 7A Wal-Mart Plaza, Rte.18 Monaca PA 15061 General Provider Beaver<br />
Rinchuse Dara Katsur <strong>Dental</strong> & Orthodontics 7A Wal-Mart Plaza, Rte.18 Monaca PA 15061 Orthodontist Beaver<br />
Schmidt Alan 000000001075 Katsur <strong>Dental</strong> & Orthodontics 7A Wal-Mart Plaza, Rte.18 Monaca PA 15061 General Provider Beaver<br />
Smiga Ingrid 000000001075 Katsur <strong>Dental</strong> & Orthodontics 7A Wal-Mart Plaza, Rte.18 Monaca PA 15061 General Provider Beaver<br />
Stein Mark 000000001075 Katsur <strong>Dental</strong> & Orthodontics 7A Wal-Mart Plaza, Rte.18 Monaca PA 15061 General Provider Beaver<br />
Tinnemeyer Anjuli 000000001075 Katsur <strong>Dental</strong> & Orthodontics 7A Wal-Mart Plaza, Rte.18 Monaca PA 15061 General Provider Beaver<br />
Zalakar Frank 000000001075 Katsur <strong>Dental</strong> & Orthodontics 7A Wal-Mart Plaza, Rte.18 Monaca PA 15061 General Provider Beaver<br />
Dandashi Moutaz Katsur <strong>Dental</strong> & Orthodontics Specialists 7A Wal-Mart Plaza, Route 18 Monaca PA 15061 Pedodontist Beaver<br />
Hertzler L Gregory Katsur <strong>Dental</strong> & Orthodontics Specialists 7A Wal-Mart Plaza, Route 18 Monaca PA 15061 Oral Surgeon Beaver<br />
Kelly Derek Katsur <strong>Dental</strong> & Orthodontics Specialists 7A Wal-Mart Plaza, Route 18 Monaca PA 15061 Oral Surgeon Beaver<br />
Kier Gregory Katsur <strong>Dental</strong> & Orthodontics Specialists 7A Wal-Mart Plaza, Route 18 Monaca PA 15061 Periodontist Beaver<br />
Monti Richard Katsur <strong>Dental</strong> & Orthodontics Specialists 7A Wal-Mart Plaza, Route 18 Monaca PA 15061 Oral Surgeon Beaver<br />
Panossian Antoine A+ Oral Surgery Specialty Care PC 2230 North 5th St Hwy Reading PA 19605 Oral Surgeon Berks<br />
Evans Marianna Allied Orthodontics PC 2230 N 5th St Hwy Reading PA 19605 Orthodontist Berks<br />
Babameto Blendi Aspen <strong>Dental</strong> Associates of NY., P.C. 2733 Papermill Road Reading PA 19610 Oral Surgeon Berks<br />
Brier Ashley 000000002360 Aspen <strong>Dental</strong> Associates of NY., P.C. 2733 Papermill Road Reading PA 19610 General Provider Berks<br />
Ciarallo Robert Aspen <strong>Dental</strong> Associates of NY., P.C. 2733 Papermill Road Reading PA 19610 Oral Surgeon Berks<br />
Fellin Michael 000000002360 Aspen <strong>Dental</strong> Associates of NY., P.C. 2733 Papermill Road Reading PA 19610 General Provider Berks<br />
Singh Tanvir 000000002360 Aspen <strong>Dental</strong> Associates of NY., P.C. 2733 Papermill Road Reading PA 19610 General Provider Berks<br />
Withanachchi Janatha Aspen <strong>Dental</strong> Associates of NY., P.C. 2733 Papermill Road Reading PA 19610 Endodontist Berks<br />
Young Donovan 000000002360 Aspen <strong>Dental</strong> Associates of NY., P.C. 2733 Papermill Road Reading PA 19610 General Provider Berks<br />
Diak Steven 000000000973 <strong>Dental</strong> Health <strong>Services</strong> 1901 Ridgewood Rd. Wyomissing PA 19610 General Provider Berks<br />
Lee Young 000000000973 <strong>Dental</strong> Health <strong>Services</strong> 1901 Ridgewood Rd. Wyomissing PA 19610 General Provider Berks<br />
Check Jennifer 000000050334 Aspen <strong>Dental</strong> 3420 Pleasant Valley Blvd Altoona PA 16602 General Provider Blair<br />
Ciarallo Robert Aspen <strong>Dental</strong> 3420 Pleasant Valley Blvd Altoona PA 16602 Oral Surgeon Blair<br />
Cignetti Scott 000000050334 Aspen <strong>Dental</strong> 3420 Pleasant Valley Blvd Altoona PA 16602 General Provider Blair<br />
Fazio John 000000050334 Aspen <strong>Dental</strong> 3420 Pleasant Valley Blvd Altoona PA 16602 General Provider Blair<br />
Ferguson III William 000000050334 Aspen <strong>Dental</strong> 3420 Pleasant Valley Blvd Altoona PA 16602 General Provider Blair<br />
Grinberg Anna 000000050334 Aspen <strong>Dental</strong> 3420 Pleasant Valley Blvd Altoona PA 16602 General Provider Blair<br />
Malone Matthew 000000050334 Aspen <strong>Dental</strong> 3420 Pleasant Valley Blvd Altoona PA 16602 General Provider Blair<br />
McCann Eve 000000050334 Aspen <strong>Dental</strong> 3420 Pleasant Valley Blvd Altoona PA 16602 General Provider Blair<br />
McClain Kelly 000000050334 Aspen <strong>Dental</strong> 3420 Pleasant Valley Blvd Altoona PA 16602 General Provider Blair<br />
Monios George 000000050334 Aspen <strong>Dental</strong> 3420 Pleasant Valley Blvd Altoona PA 16602 General Provider Blair<br />
Raja Nabila 000000050334 Aspen <strong>Dental</strong> 3420 Pleasant Valley Blvd Altoona PA 16602 General Provider Blair<br />
Somers Mitchell 000000050334 Aspen <strong>Dental</strong> 3420 Pleasant Valley Blvd Altoona PA 16602 General Provider Blair<br />
Tam Dominic 000000050334 Aspen <strong>Dental</strong> 3420 Pleasant Valley Blvd Altoona PA 16602 General Provider Blair<br />
Agrawal Avanti 000000002349 A-1 Family <strong>Dental</strong> Care PC 1950 Street Road, Suite 200 Bensalem PA 19020 General Provider Bucks<br />
Ahmadzadeh Bijan 000000002349 A-1 Family <strong>Dental</strong> Care PC 1950 Street Road, Suite 200 Bensalem PA 19020 General Provider Bucks<br />
Chakraborty Rajashree 000000002349 A-1 Family <strong>Dental</strong> Care PC 1950 Street Road, Suite 200 Bensalem PA 19020 General Provider Bucks<br />
Dapkute Ingrida 000000002349 A-1 Family <strong>Dental</strong> Care PC 1950 Street Road, Suite 200 Bensalem PA 19020 General Provider Bucks<br />
Derosa Daniel 000000002349 A-1 Family <strong>Dental</strong> Care PC 1950 Street Road, Suite 200 Bensalem PA 19020 General Provider Bucks<br />
Gobron Adina 000000002349 A-1 Family <strong>Dental</strong> Care PC 1950 Street Road, Suite 200 Bensalem PA 19020 General Provider Bucks<br />
Gundabathula Sindhu 000000002349 A-1 Family <strong>Dental</strong> Care PC 1950 Street Road, Suite 200 Bensalem PA 19020 General Provider Bucks<br />
Merin Jared 000000002349 A-1 Family <strong>Dental</strong> Care PC 1950 Street Road, Suite 200 Bensalem PA 19020 General Provider Bucks<br />
Mitelman Alexandra 000000002349 A-1 Family <strong>Dental</strong> Care PC 1950 Street Road, Suite 200 Bensalem PA 19020 General Provider Bucks<br />
Moriarty Sean 000000002349 A-1 Family <strong>Dental</strong> Care PC 1950 Street Road, Suite 200 Bensalem PA 19020 General Provider Bucks<br />
Nayeem Arbina 000000002349 A-1 Family <strong>Dental</strong> Care PC 1950 Street Road, Suite 200 Bensalem PA 19020 General Provider Bucks<br />
Patel Ashish 000000002349 A-1 Family <strong>Dental</strong> Care PC 1950 Street Road, Suite 200 Bensalem PA 19020 General Provider Bucks<br />
Savani Bhaskar 000000002349 A-1 Family <strong>Dental</strong> Care PC 1950 Street Road, Suite 200 Bensalem PA 19020 General Provider Bucks<br />
Savani Niranjan 000000002349 A-1 Family <strong>Dental</strong> Care PC 1950 Street Road, Suite 200 Bensalem PA 19020 General Provider Bucks<br />
Todd Meredith 000000002349 A-1 Family <strong>Dental</strong> Care PC 1950 Street Road, Suite 200 Bensalem PA 19020 General Provider Bucks<br />
Vincze Bela <strong>Dentist</strong>ry 4 Kids 2075 Byberry Rd, Suite 101 Bensalem PA 19020 Pedodontist Bucks<br />
Hodges Kellyn Dr Kellyn Hodges DMD 2212 Street Rd Bensalem PA 19020 Orthodontist Bucks<br />
Sakkal Sameh 000000002781 Mohamed Sakkal, D.M.D. 1541 Brookwood Drive Bensalem PA 19020 General Provider Bucks<br />
Patel Mukund 000000001203 Mukund K. Patel, D.D.S., P.C. 2776 Knights Rd. Bensalem PA 19020 General Provider Bucks<br />
Kahlon Sonia Rich Family Orthodontics 3554 Hulmeville Rd, Suite 110 Bensalem PA 19020 Orthodontist Bucks<br />
Rich Jeremy Rich Family Orthodontics 3554 Hulmeville Rd, Suite 110 Bensalem PA 19020 Orthodontist Bucks<br />
Agrawal Avanti 000000002352 A+ Family <strong>Dental</strong> Care PC 1500 Horizon Drive, Suite 104 Chalfont PA 18914 General Provider Bucks<br />
Ahmadzadeh Bijan 000000002352 A+ Family <strong>Dental</strong> Care PC 1500 Horizon Drive, Suite 104 Chalfont PA 18914 General Provider Bucks<br />
Dapkute Ingrida 000000002352 A+ Family <strong>Dental</strong> Care PC 1500 Horizon Drive, Suite 104 Chalfont PA 18914 General Provider Bucks<br />
Derosa Daniel 000000002352 A+ Family <strong>Dental</strong> Care PC 1500 Horizon Drive, Suite 104 Chalfont PA 18914 General Provider Bucks<br />
Gobron Adina 000000002352 A+ Family <strong>Dental</strong> Care PC 1500 Horizon Drive, Suite 104 Chalfont PA 18914 General Provider Bucks<br />
Kandov Olga 000000002352 A+ Family <strong>Dental</strong> Care PC 1500 Horizon Drive, Suite 104 Chalfont PA 18914 General Provider Bucks<br />
Merin Jared 000000002352 A+ Family <strong>Dental</strong> Care PC 1500 Horizon Drive, Suite 104 Chalfont PA 18914 General Provider Bucks<br />
* Indicates dentist that is accepting current patients only.<br />
All <strong>Select</strong> <strong>Plan</strong> <strong>Dentist</strong>s Page 17<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 <strong>Dentist</strong>. Fac ID is used to indicate which facility a member chooses.
SELECT PLAN 1 DENTIST DIRECTORY<br />
<strong>Dentist</strong>s listed are under contract as of 9/1/12<br />
Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />
Mitelman Alexandra 000000002352 A+ Family <strong>Dental</strong> Care PC 1500 Horizon Drive, Suite 104 Chalfont PA 18914 General Provider Bucks<br />
Moriarty Sean 000000002352 A+ Family <strong>Dental</strong> Care PC 1500 Horizon Drive, Suite 104 Chalfont PA 18914 General Provider Bucks<br />
Savani Bhaskar 000000002352 A+ Family <strong>Dental</strong> Care PC 1500 Horizon Drive, Suite 104 Chalfont PA 18914 General Provider Bucks<br />
Savani Niranjan 000000002352 A+ Family <strong>Dental</strong> Care PC 1500 Horizon Drive, Suite 104 Chalfont PA 18914 General Provider Bucks<br />
Simeone Mark 000000002352 A+ Family <strong>Dental</strong> Care PC 1500 Horizon Drive, Suite 104 Chalfont PA 18914 General Provider Bucks<br />
Todd Meredith 000000002352 A+ Family <strong>Dental</strong> Care PC 1500 Horizon Drive, Suite 104 Chalfont PA 18914 General Provider Bucks<br />
Bandelac Georges A+ Periodontic Specialty Care PC 1500 Horizon Dr, Suite 104 Chalfont PA 18914 Periodontist Bucks<br />
Evans Marianna A+ Periodontic Specialty Care PC 1500 Horizon Dr, Suite 104 Chalfont PA 18914 Periodontist Bucks<br />
Patel Prafulchandra 000000039700 American <strong>Dental</strong> Care LLC 817 North Easton Road Doylestown PA 18901 General Provider Bucks<br />
Rudolf Donald Donald Rudolf, D.D.S.,P.C. 103 Progress Drive Doylestown PA 18901 Oral Surgeon Bucks<br />
Evans Marianna Allied Orthodontics PC 4259 W Swamp Rd, Suite 104 Doylestown PA 18902 Orthodontist Bucks<br />
Agrawal Avanti 000000070931 Ardent Smile 4259 W Swamp Rd Doylestown PA 18902 General Provider Bucks<br />
Derosa Daniel 000000070931 Ardent Smile 4259 W Swamp Rd Doylestown PA 18902 General Provider Bucks<br />
Thoma Fjoralba 000000070931 Ardent Smile 4259 W Swamp Rd Doylestown PA 18902 General Provider Bucks<br />
Todd Meredith 000000070931 Ardent Smile 4259 W Swamp Rd Doylestown PA 18902 General Provider Bucks<br />
Vinnikov Inna 000000070931 Ardent Smile 4259 W Swamp Rd Doylestown PA 18902 General Provider Bucks<br />
Patel Nalin 000000000387 Fairless Hills <strong>Dental</strong> Group 532 S. Oxford Valley Rd. Fairless Hills PA 19030 General Provider Bucks<br />
Barot Ashok 000000079782 PA <strong>Dental</strong> Group 320 N Oxford Valley Rd Fairless Hills PA 19030 General Provider Bucks<br />
He Yuling 000000079782 PA <strong>Dental</strong> Group 320 N Oxford Valley Rd Fairless Hills PA 19030 General Provider Bucks<br />
Jeong Jihyon 000000079782 PA <strong>Dental</strong> Group 320 N Oxford Valley Rd Fairless Hills PA 19030 General Provider Bucks<br />
Patmidi Avanti 000000079782 PA <strong>Dental</strong> Group 320 N Oxford Valley Rd Fairless Hills PA 19030 General Provider Bucks<br />
Reddy Hima 000000079782 PA <strong>Dental</strong> Group 320 N Oxford Valley Rd Fairless Hills PA 19030 General Provider Bucks<br />
Rotwein Benjamin 000000079782 PA <strong>Dental</strong> Group 320 N Oxford Valley Rd Fairless Hills PA 19030 General Provider Bucks<br />
Tadisena Archana 000000079782 PA <strong>Dental</strong> Group 320 N Oxford Valley Rd Fairless Hills PA 19030 General Provider Bucks<br />
Goldin Sofia 000000001908 Sofia Goldin, D.M.D. 227 Bustleton Pike Feasterville Trevose PA 19053 General Provider Bucks<br />
Agrawal Avanti 000000002350 A-1 Family <strong>Dental</strong> Care PC 404 Middletown Boulevard,, Suite 300 Langhorne PA 19047 General Provider Bucks<br />
Ahmadzadeh Bijan 000000002350 A-1 Family <strong>Dental</strong> Care PC 404 Middletown Boulevard,, Suite 300 Langhorne PA 19047 General Provider Bucks<br />
Cheema Tandeep 000000002350 A-1 Family <strong>Dental</strong> Care PC 404 Middletown Boulevard,, Suite 300 Langhorne PA 19047 General Provider Bucks<br />
Dapkute Ingrida 000000002350 A-1 Family <strong>Dental</strong> Care PC 404 Middletown Boulevard,, Suite 300 Langhorne PA 19047 General Provider Bucks<br />
Derosa Daniel 000000002350 A-1 Family <strong>Dental</strong> Care PC 404 Middletown Boulevard,, Suite 300 Langhorne PA 19047 General Provider Bucks<br />
Gobron Adina 000000002350 A-1 Family <strong>Dental</strong> Care PC 404 Middletown Boulevard,, Suite 300 Langhorne PA 19047 General Provider Bucks<br />
Haribabu Vasanthi 000000002350 A-1 Family <strong>Dental</strong> Care PC 404 Middletown Boulevard,, Suite 300 Langhorne PA 19047 General Provider Bucks<br />
Katikaneni Ramkumar 000000002350 A-1 Family <strong>Dental</strong> Care PC 404 Middletown Boulevard,, Suite 300 Langhorne PA 19047 General Provider Bucks<br />
Merin Jared 000000002350 A-1 Family <strong>Dental</strong> Care PC 404 Middletown Boulevard,, Suite 300 Langhorne PA 19047 General Provider Bucks<br />
Mitelman Alexandra 000000002350 A-1 Family <strong>Dental</strong> Care PC 404 Middletown Boulevard,, Suite 300 Langhorne PA 19047 General Provider Bucks<br />
Moriarty Sean 000000002350 A-1 Family <strong>Dental</strong> Care PC 404 Middletown Boulevard,, Suite 300 Langhorne PA 19047 General Provider Bucks<br />
Nanda Ranveet 000000002350 A-1 Family <strong>Dental</strong> Care PC 404 Middletown Boulevard,, Suite 300 Langhorne PA 19047 General Provider Bucks<br />
Pahng Christine 000000002350 A-1 Family <strong>Dental</strong> Care PC 404 Middletown Boulevard,, Suite 300 Langhorne PA 19047 General Provider Bucks<br />
Savani Bhaskar 000000002350 A-1 Family <strong>Dental</strong> Care PC 404 Middletown Boulevard,, Suite 300 Langhorne PA 19047 General Provider Bucks<br />
Savani Niranjan 000000002350 A-1 Family <strong>Dental</strong> Care PC 404 Middletown Boulevard,, Suite 300 Langhorne PA 19047 General Provider Bucks<br />
Todd Meredith 000000002350 A-1 Family <strong>Dental</strong> Care PC 404 Middletown Boulevard,, Suite 300 Langhorne PA 19047 General Provider Bucks<br />
Evans Marianna Allied Orthodontics PC 402 Middletown Blvd, Suite 200 Langhorne PA 19047 Orthodontist Bucks<br />
Kahlon Sonia Rich Family Orthodontics 370 Middletown Blvd, 509 Langhorne PA 19047 Orthodontist Bucks<br />
Rich Jeremy Rich Family Orthodontics 370 Middletown Blvd, 509 Langhorne PA 19047 Orthodontist Bucks<br />
Lehrhaupt Solomon 000000081561 AllRight <strong>Dental</strong>, PC 229 Plaza Blvd Morrisville PA 19067 General Provider Bucks<br />
Sambaraju Haritha 000000081561 AllRight <strong>Dental</strong>, PC 229 Plaza Blvd Morrisville PA 19067 General Provider Bucks<br />
Vora Vasant 000000000837 Vasant K. Vora, D.D.S. 301 Oxford Valley Rd., Suite 203A Morrisville PA 19067 General Provider Bucks<br />
Yates M. Alan M. Alan Yates, D.M.D. 638 Newton-Yardley Rd., Suite 2A Newtown PA 18940 Oral Surgeon Bucks<br />
Goldberger Harvey 000000000379 Smile Maker <strong>Dental</strong> 26 Eagle Rd. Newtown PA 18940 General Provider Bucks<br />
Agrawal Avanti 000000001023 A+ Family <strong>Dental</strong> Care PC 24 South 14th Street Quakertown PA 18951 General Provider Bucks<br />
Ahmadzadeh Bijan 000000001023 A+ Family <strong>Dental</strong> Care PC 24 South 14th Street Quakertown PA 18951 General Provider Bucks<br />
Bindra Atalinder 000000001023 A+ Family <strong>Dental</strong> Care PC 24 South 14th Street Quakertown PA 18951 General Provider Bucks<br />
Chong Woojae A+ Family <strong>Dental</strong> Care PC 24 South 14th Street Quakertown PA 18951 Periodontist Bucks<br />
Dapkute Ingrida 000000001023 A+ Family <strong>Dental</strong> Care PC 24 South 14th Street Quakertown PA 18951 General Provider Bucks<br />
Derosa Daniel 000000001023 A+ Family <strong>Dental</strong> Care PC 24 South 14th Street Quakertown PA 18951 General Provider Bucks<br />
Gherca Mirabela 000000001023 A+ Family <strong>Dental</strong> Care PC 24 South 14th Street Quakertown PA 18951 General Provider Bucks<br />
Gobron Adina 000000001023 A+ Family <strong>Dental</strong> Care PC 24 South 14th Street Quakertown PA 18951 General Provider Bucks<br />
Hong Seong 000000001023 A+ Family <strong>Dental</strong> Care PC 24 South 14th Street Quakertown PA 18951 General Provider Bucks<br />
Liang Yuling 000000001023 A+ Family <strong>Dental</strong> Care PC 24 South 14th Street Quakertown PA 18951 General Provider Bucks<br />
Merin Jared 000000001023 A+ Family <strong>Dental</strong> Care PC 24 South 14th Street Quakertown PA 18951 General Provider Bucks<br />
Mitelman Alexandra 000000001023 A+ Family <strong>Dental</strong> Care PC 24 South 14th Street Quakertown PA 18951 General Provider Bucks<br />
Moriarty Sean 000000001023 A+ Family <strong>Dental</strong> Care PC 24 South 14th Street Quakertown PA 18951 General Provider Bucks<br />
Patoliya Keyur 000000001023 A+ Family <strong>Dental</strong> Care PC 24 South 14th Street Quakertown PA 18951 General Provider Bucks<br />
Savani Bhaskar 000000001023 A+ Family <strong>Dental</strong> Care PC 24 South 14th Street Quakertown PA 18951 General Provider Bucks<br />
Savani Niranjan 000000001023 A+ Family <strong>Dental</strong> Care PC 24 South 14th Street Quakertown PA 18951 General Provider Bucks<br />
Tantucco Kathleen 000000001023 A+ Family <strong>Dental</strong> Care PC 24 South 14th Street Quakertown PA 18951 General Provider Bucks<br />
* Indicates dentist that is accepting current patients only.<br />
All <strong>Select</strong> <strong>Plan</strong> <strong>Dentist</strong>s Page 18<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 <strong>Dentist</strong>. Fac ID is used to indicate which facility a member chooses.
SELECT PLAN 1 DENTIST DIRECTORY<br />
<strong>Dentist</strong>s listed are under contract as of 9/1/12<br />
Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />
Todd Meredith 000000001023 A+ Family <strong>Dental</strong> Care PC 24 South 14th Street Quakertown PA 18951 General Provider Bucks<br />
Bandelac Georges A+ Periodontic Specialty Care PC 24 S 14th St Quakertown PA 18951 Periodontist Bucks<br />
Evans Marianna A+ Periodontic Specialty Care PC 24 S 14th St Quakertown PA 18951 Periodontist Bucks<br />
Evans Marianna Allied Orthodontics PC 24 S 14th St Quakertown PA 18951 Orthodontist Bucks<br />
Bhatnagar Payal 000000078266 Aspen <strong>Dental</strong> 90 North West End Blvd Quakertown PA 18951 General Provider Bucks<br />
Chadha Chandan 000000078266 Aspen <strong>Dental</strong> 90 North West End Blvd Quakertown PA 18951 General Provider Bucks<br />
Kim Peter 000000078266 Aspen <strong>Dental</strong> 90 North West End Blvd Quakertown PA 18951 General Provider Bucks<br />
Malhotra Swati 000000078266 Aspen <strong>Dental</strong> 90 North West End Blvd Quakertown PA 18951 General Provider Bucks<br />
Obaid Michel 000000078266 Aspen <strong>Dental</strong> 90 North West End Blvd Quakertown PA 18951 General Provider Bucks<br />
Sambaraju Haritha 000000078266 Aspen <strong>Dental</strong> 90 North West End Blvd Quakertown PA 18951 General Provider Bucks<br />
Withanachchi Janatha Aspen <strong>Dental</strong> 90 North West End Blvd Quakertown PA 18951 Endodontist Bucks<br />
Yi Tyler 000000078266 Aspen <strong>Dental</strong> 90 North West End Blvd Quakertown PA 18951 General Provider Bucks<br />
Sayles Erik Drs. Schwartz & Schelkun Associates Brownstone Office Complex, 853 2nd St. Pke, Ste.A- Richboro PA 18954 Oral Surgeon Bucks<br />
Schelkun Paul Drs. Schwartz & Schelkun Associates Brownstone Office Complex, 853 2nd St. Pke, Ste.A- Richboro PA 18954 Oral Surgeon Bucks<br />
Metz August 000000069529 Apex Smiles LLC 771 2nd St Pike Southampton PA 18966 General Provider Bucks<br />
Cichetti Michael Cichetti & DelliGatti Orthodontics PC 928 Jaymor Rd, Suite 130A Southampton PA 18966 Orthodontist Bucks<br />
DelliGatti Steve Cichetti & DelliGatti Orthodontics PC 928 Jaymor Rd, Suite 130A Southampton PA 18966 Orthodontist Bucks<br />
Milewski Michael Cichetti & DelliGatti Orthodontics PC 928 Jaymor Rd, Suite 130A Southampton PA 18966 Orthodontist Bucks<br />
Orozco Jacob Cichetti & DelliGatti Orthodontics PC 928 Jaymor Rd, Suite 130A Southampton PA 18966 Orthodontist Bucks<br />
Bahn Paul Pediatric <strong>Dental</strong> Associates 928 Jaymor Rd, Suite 130 A Southampton PA 18966 Pedodontist Bucks<br />
D'Agostino Alegra Pediatric <strong>Dental</strong> Associates 928 Jaymor Rd, Suite 130 A Southampton PA 18966 Pedodontist Bucks<br />
Hamilton Sharon Pediatric <strong>Dental</strong> Associates 928 Jaymor Rd, Suite 130 A Southampton PA 18966 Pedodontist Bucks<br />
Kay Lewis Pediatric <strong>Dental</strong> Associates 928 Jaymor Rd, Suite 130 A Southampton PA 18966 Pedodontist Bucks<br />
Quinn Noah Pediatric <strong>Dental</strong> Associates 928 Jaymor Rd, Suite 130 A Southampton PA 18966 Pedodontist Bucks<br />
Rosenbaum Michael Pediatric <strong>Dental</strong> Associates 928 Jaymor Rd, Suite 130 A Southampton PA 18966 Pedodontist Bucks<br />
Thomas Kimberly Pediatric <strong>Dental</strong> Associates 928 Jaymor Rd, Suite 130 A Southampton PA 18966 Pedodontist Bucks<br />
Sayles Erik Drs. Schwartz & Schelkun Associates 158 York Road Warminster PA 18974 Oral Surgeon Bucks<br />
Schelkun Paul Drs. Schwartz & Schelkun Associates 158 York Road Warminster PA 18974 Oral Surgeon Bucks<br />
Lee Elliot 000000078283 Warrington <strong>Dental</strong> Arts 865 Easton Road, Suite 110 Warrington PA 18976 General Provider Bucks<br />
Yoo Joo 000000078283 Warrington <strong>Dental</strong> Arts 865 Easton Road, Suite 110 Warrington PA 18976 General Provider Bucks<br />
Dudhat Dilip 000000040338 Radiant Smiles at Floral Vale 117 Floral Vale Blvd Yardley PA 19067 General Provider Bucks<br />
Hazard Amelia 000000040338 Radiant Smiles at Floral Vale 117 Floral Vale Blvd Yardley PA 19067 General Provider Bucks<br />
Kalanuria Vinita 000000040338 Radiant Smiles at Floral Vale 117 Floral Vale Blvd Yardley PA 19067 General Provider Bucks<br />
Metz August 000000040338 Radiant Smiles at Floral Vale 117 Floral Vale Blvd Yardley PA 19067 General Provider Bucks<br />
Zalavadia Nikunj 000000040338 Radiant Smiles at Floral Vale 117 Floral Vale Blvd Yardley PA 19067 General Provider Bucks<br />
Aviso Venice 000000038072 Smile Today <strong>Dental</strong> LLC 301 Oxford Valley Rd, Suite 1301 Yardley PA 19067 General Provider Bucks<br />
Phan Kathy 000000038072 Smile Today <strong>Dental</strong> LLC 301 Oxford Valley Rd, Suite 1301 Yardley PA 19067 General Provider Bucks<br />
Ciarallo Robert Aspen <strong>Dental</strong> of Butler 256 New Castle Rd Butler PA 16001 Oral Surgeon Butler<br />
Garver Eric 000000037964 Aspen <strong>Dental</strong> of Butler 256 New Castle Rd Butler PA 16001 General Provider Butler<br />
Grinberg Anna 000000037964 Aspen <strong>Dental</strong> of Butler 256 New Castle Rd Butler PA 16001 General Provider Butler<br />
Laughrey Nathan 000000037964 Aspen <strong>Dental</strong> of Butler 256 New Castle Rd Butler PA 16001 General Provider Butler<br />
Ruprecht Heather 000000037964 Aspen <strong>Dental</strong> of Butler 256 New Castle Rd Butler PA 16001 General Provider Butler<br />
Hiras John 000000001348 Butler <strong>Dental</strong> Associates 121 South Main Street Butler PA 16001 General Provider Butler<br />
Manalo Maria 000000001348 Butler <strong>Dental</strong> Associates 121 South Main Street Butler PA 16001 General Provider Butler<br />
Terasavage William 000000001348 Butler <strong>Dental</strong> Associates 121 South Main Street Butler PA 16001 General Provider Butler<br />
Conquest Matthew Snyder and Dugar Oral and Maxillofacial Surgery 373 Stirling Village Butler PA 16001 Oral Surgeon Butler<br />
Dugan Michael Snyder and Dugar Oral and Maxillofacial Surgery 373 Stirling Village Butler PA 16001 Oral Surgeon Butler<br />
Snyder Richard Snyder and Dugar Oral and Maxillofacial Surgery 373 Stirling Village Butler PA 16001 Oral Surgeon Butler<br />
Sweeney Patrick Snyder and Dugar Oral and Maxillofacial Surgery 373 Stirling Village Butler PA 16001 Oral Surgeon Butler<br />
Garver Eric 000000050865 Aspen <strong>Dental</strong> 20000 Route 19, Suite 300 Cranberry Township PA 16066 General Provider Butler<br />
Grinberg Anna 000000050865 Aspen <strong>Dental</strong> 20000 Route 19, Suite 300 Cranberry Township PA 16066 General Provider Butler<br />
Laughrey Nathan 000000050865 Aspen <strong>Dental</strong> 20000 Route 19, Suite 300 Cranberry Township PA 16066 General Provider Butler<br />
Ruprecht Heather 000000050865 Aspen <strong>Dental</strong> 20000 Route 19, Suite 300 Cranberry Township PA 16066 General Provider Butler<br />
Morrow Bartley 000000001450 Generational <strong>Dental</strong> Associates 2610 Rochester Road Cranberry Township PA 16066 General Provider Butler<br />
Kampas Ronald Kampas Orthodontics PC 7011 Crider Rd, Suite 104 Mars PA 16046 Orthodontist Butler<br />
Manalo Alfredo North Pointe <strong>Dental</strong> Associates 7031 Crider Road, Suite 200 Mars PA 16046 Oral Surgeon Butler<br />
Novotny Greg 000000037626 Allied <strong>Dental</strong> Group, Ltd. 234 S. Main St. Slippery Rock PA 16057 General Provider Butler<br />
Kampas Ronald Kampas Orthodontics PC 508 S Main St, Suite 103 Zelienople PA 16063 Orthodontist Butler<br />
Conquest Matthew Snyder and Dugar Oral and Maxillofacial Surgery 506 S. Main Street, Suite 2101 Zelienople PA 16063 Oral Surgeon Butler<br />
Dugan Michael Snyder and Dugar Oral and Maxillofacial Surgery 506 S. Main Street, Suite 2101 Zelienople PA 16063 Oral Surgeon Butler<br />
Snyder Richard Snyder and Dugar Oral and Maxillofacial Surgery 506 S. Main Street, Suite 2101 Zelienople PA 16063 Oral Surgeon Butler<br />
Sweeney Patrick Snyder and Dugar Oral and Maxillofacial Surgery 506 S. Main Street, Suite 2101 Zelienople PA 16063 Oral Surgeon Butler<br />
Check Jennifer 000000002756 Aspen <strong>Dental</strong> 121 Town Center Dr. Johnstown PA 15904 General Provider Cambria<br />
Ciarallo Robert Aspen <strong>Dental</strong> 121 Town Center Dr. Johnstown PA 15904 Oral Surgeon Cambria<br />
Cignetti Scott 000000002756 Aspen <strong>Dental</strong> 121 Town Center Dr. Johnstown PA 15904 General Provider Cambria<br />
Fazio John 000000002756 Aspen <strong>Dental</strong> 121 Town Center Dr. Johnstown PA 15904 General Provider Cambria<br />
* Indicates dentist that is accepting current patients only.<br />
All <strong>Select</strong> <strong>Plan</strong> <strong>Dentist</strong>s Page 19<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 <strong>Dentist</strong>. Fac ID is used to indicate which facility a member chooses.
SELECT PLAN 1 DENTIST DIRECTORY<br />
<strong>Dentist</strong>s listed are under contract as of 9/1/12<br />
Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />
Ferguson III William 000000002756 Aspen <strong>Dental</strong> 121 Town Center Dr. Johnstown PA 15904 General Provider Cambria<br />
Grinberg Anna 000000002756 Aspen <strong>Dental</strong> 121 Town Center Dr. Johnstown PA 15904 General Provider Cambria<br />
Malone Matthew 000000002756 Aspen <strong>Dental</strong> 121 Town Center Dr. Johnstown PA 15904 General Provider Cambria<br />
McCann Eve 000000002756 Aspen <strong>Dental</strong> 121 Town Center Dr. Johnstown PA 15904 General Provider Cambria<br />
McClain Kelly 000000002756 Aspen <strong>Dental</strong> 121 Town Center Dr. Johnstown PA 15904 General Provider Cambria<br />
Monios George 000000002756 Aspen <strong>Dental</strong> 121 Town Center Dr. Johnstown PA 15904 General Provider Cambria<br />
Raja Nabila 000000002756 Aspen <strong>Dental</strong> 121 Town Center Dr. Johnstown PA 15904 General Provider Cambria<br />
Somers Mitchell 000000002756 Aspen <strong>Dental</strong> 121 Town Center Dr. Johnstown PA 15904 General Provider Cambria<br />
Tam Dominic 000000002756 Aspen <strong>Dental</strong> 121 Town Center Dr. Johnstown PA 15904 General Provider Cambria<br />
Burnheimer John John M. Burnheimer, D.M.D., P.C. 336 Bloomfield Street Johnstown PA 15904 Orthodontist Cambria<br />
Check Jennifer 000000038064 Aspen <strong>Dental</strong> 1715 N Atherton St State College PA 16803 General Provider Centre<br />
Ciarallo Robert Aspen <strong>Dental</strong> 1715 N Atherton St State College PA 16803 Oral Surgeon Centre<br />
Cignetti Scott 000000038064 Aspen <strong>Dental</strong> 1715 N Atherton St State College PA 16803 General Provider Centre<br />
Fazio John 000000038064 Aspen <strong>Dental</strong> 1715 N Atherton St State College PA 16803 General Provider Centre<br />
Ferguson III William 000000038064 Aspen <strong>Dental</strong> 1715 N Atherton St State College PA 16803 General Provider Centre<br />
Grinberg Anna 000000038064 Aspen <strong>Dental</strong> 1715 N Atherton St State College PA 16803 General Provider Centre<br />
Malone Matthew 000000038064 Aspen <strong>Dental</strong> 1715 N Atherton St State College PA 16803 General Provider Centre<br />
McCann Eve 000000038064 Aspen <strong>Dental</strong> 1715 N Atherton St State College PA 16803 General Provider Centre<br />
McClain Kelly 000000038064 Aspen <strong>Dental</strong> 1715 N Atherton St State College PA 16803 General Provider Centre<br />
Monios George 000000038064 Aspen <strong>Dental</strong> 1715 N Atherton St State College PA 16803 General Provider Centre<br />
Raja Nabila 000000038064 Aspen <strong>Dental</strong> 1715 N Atherton St State College PA 16803 General Provider Centre<br />
Somers Mitchell 000000038064 Aspen <strong>Dental</strong> 1715 N Atherton St State College PA 16803 General Provider Centre<br />
Tam Dominic 000000038064 Aspen <strong>Dental</strong> 1715 N Atherton St State College PA 16803 General Provider Centre<br />
Gretzula Chad Absolute Oral Surgery PC 616 E Lancaster Ave Berwyn PA 19312 Oral Surgeon Chester<br />
Bandelac Georges A+ Periodontic Specialty Care PC 479 Thomas Jones Way, Suite 600 Exton PA 19341 Periodontist Chester<br />
Evans Marianna A+ Periodontic Specialty Care PC 479 Thomas Jones Way, Suite 600 Exton PA 19341 Periodontist Chester<br />
Evans Marianna Allied Orthodontics PC 479 Thomas Jones Way, Suite 600 Exton PA 19341 Orthodontist Chester<br />
Agrawal Avanti 000000050386 American Family <strong>Dental</strong> Care PC 479 Thomas Jones Way, Suite 600 Exton PA 19341 General Provider Chester<br />
Ahmadzadeh Bijan 000000050386 American Family <strong>Dental</strong> Care PC 479 Thomas Jones Way, Suite 600 Exton PA 19341 General Provider Chester<br />
Brown Benjamin 000000050386 American Family <strong>Dental</strong> Care PC 479 Thomas Jones Way, Suite 600 Exton PA 19341 General Provider Chester<br />
Dapkute Ingrida 000000050386 American Family <strong>Dental</strong> Care PC 479 Thomas Jones Way, Suite 600 Exton PA 19341 General Provider Chester<br />
Derosa Daniel 000000050386 American Family <strong>Dental</strong> Care PC 479 Thomas Jones Way, Suite 600 Exton PA 19341 General Provider Chester<br />
Gobron Adina 000000050386 American Family <strong>Dental</strong> Care PC 479 Thomas Jones Way, Suite 600 Exton PA 19341 General Provider Chester<br />
Kim Sunghun 000000050386 American Family <strong>Dental</strong> Care PC 479 Thomas Jones Way, Suite 600 Exton PA 19341 General Provider Chester<br />
Merin Jared 000000050386 American Family <strong>Dental</strong> Care PC 479 Thomas Jones Way, Suite 600 Exton PA 19341 General Provider Chester<br />
Mitelman Alexandra 000000050386 American Family <strong>Dental</strong> Care PC 479 Thomas Jones Way, Suite 600 Exton PA 19341 General Provider Chester<br />
Moriarty Sean 000000050386 American Family <strong>Dental</strong> Care PC 479 Thomas Jones Way, Suite 600 Exton PA 19341 General Provider Chester<br />
Nguyen Anna 000000050386 American Family <strong>Dental</strong> Care PC 479 Thomas Jones Way, Suite 600 Exton PA 19341 General Provider Chester<br />
Savani Bhaskar 000000050386 American Family <strong>Dental</strong> Care PC 479 Thomas Jones Way, Suite 600 Exton PA 19341 General Provider Chester<br />
Savani Niranjan 000000050386 American Family <strong>Dental</strong> Care PC 479 Thomas Jones Way, Suite 600 Exton PA 19341 General Provider Chester<br />
Soliman John 000000050386 American Family <strong>Dental</strong> Care PC 479 Thomas Jones Way, Suite 600 Exton PA 19341 General Provider Chester<br />
Todd Meredith 000000050386 American Family <strong>Dental</strong> Care PC 479 Thomas Jones Way, Suite 600 Exton PA 19341 General Provider Chester<br />
Gorelik Tatyana 000000002317 Exton <strong>Dental</strong> Associates, LTD 436 Exton Commons Exton PA 19341 General Provider Chester<br />
Hook William William L. Hook, D.M.D., MSD 358 S. Balderston Drive Exton PA 19341 Orthodontist Chester<br />
* Yeung Alan 000000000510 Alan S Yeung, D.D.S. 250 W Lancaster Ave. #210 Paoli PA 19301 General Provider Chester<br />
Babameto Blendi Aspen <strong>Dental</strong> Associates of NY, PC 1100 Town Square Rd Pottstown PA 19465 Oral Surgeon Chester<br />
Brier Ashley 000000002742 Aspen <strong>Dental</strong> Associates of NY, PC 1100 Town Square Rd Pottstown PA 19465 General Provider Chester<br />
Ciarallo Robert Aspen <strong>Dental</strong> Associates of NY, PC 1100 Town Square Rd Pottstown PA 19465 Oral Surgeon Chester<br />
Fellin Michael 000000002742 Aspen <strong>Dental</strong> Associates of NY, PC 1100 Town Square Rd Pottstown PA 19465 General Provider Chester<br />
Singh Tanvir 000000002742 Aspen <strong>Dental</strong> Associates of NY, PC 1100 Town Square Rd Pottstown PA 19465 General Provider Chester<br />
Withanachchi Janatha Aspen <strong>Dental</strong> Associates of NY, PC 1100 Town Square Rd Pottstown PA 19465 Endodontist Chester<br />
Young Donovan 000000002742 Aspen <strong>Dental</strong> Associates of NY, PC 1100 Town Square Rd Pottstown PA 19465 General Provider Chester<br />
In Andrew 000000000628 Gentle <strong>Dental</strong> Thorndale LLC 3307 Lincoln Hwy Thorndale PA 19372 General Provider Chester<br />
Chen Thomas 000000037762 Jiten P. Gohel, DMD 913 E Boot Rd West Chester PA 19380 General Provider Chester<br />
Gohel Jiten 000000037762 Jiten P. Gohel, DMD 913 E Boot Rd West Chester PA 19380 General Provider Chester<br />
DeLoache Yvonne 000000001057 Yvonne DeLoache, D.D.S. 301 S. High Street West Chester PA 19382 General Provider Chester<br />
Barnes Willie 000000068522 Family <strong>Dentist</strong>ry 4896 Nittany Valley Dr, Box 397 Lamar PA 16848 General Provider Clinton<br />
Fleetwood Stephen 000000001747 Stephen T. Fleetwood, D.D.S. 599 Old Berwick Rd. Bloomsburg PA 17815 General Provider Columbia<br />
* Patchin Harry 000000001712 Harry V Patchin DMD 407 S 32nd St Camp Hill PA 17011 General Provider Cumberland<br />
Gensbigler Joseph 000000002527 West Shore Family <strong>Dentist</strong>ry, LTD 40 North 36th Street Camp Hill PA 17011 General Provider Cumberland<br />
Gensbigler Thomas 000000002527 West Shore Family <strong>Dentist</strong>ry, LTD 40 North 36th Street Camp Hill PA 17011 General Provider Cumberland<br />
Yelk Peter 000000002527 West Shore Family <strong>Dentist</strong>ry, LTD 40 North 36th Street Camp Hill PA 17011 General Provider Cumberland<br />
Babameto Blendi Aspen <strong>Dental</strong> 6416 Carlisle Pike, Suite 500 Mechanicsburg PA 17050 Oral Surgeon Cumberland<br />
Ciarallo Robert Aspen <strong>Dental</strong> 6416 Carlisle Pike, Suite 500 Mechanicsburg PA 17050 Oral Surgeon Cumberland<br />
Desai Jagruti 000000050403 Aspen <strong>Dental</strong> 6416 Carlisle Pike, Suite 500 Mechanicsburg PA 17050 General Provider Cumberland<br />
Kaur Kamaljit 000000050403 Aspen <strong>Dental</strong> 6416 Carlisle Pike, Suite 500 Mechanicsburg PA 17050 General Provider Cumberland<br />
* Indicates dentist that is accepting current patients only.<br />
All <strong>Select</strong> <strong>Plan</strong> <strong>Dentist</strong>s Page 20<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 <strong>Dentist</strong>. Fac ID is used to indicate which facility a member chooses.
SELECT PLAN 1 DENTIST DIRECTORY<br />
<strong>Dentist</strong>s listed are under contract as of 9/1/12<br />
Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />
Kuleva Juliana 000000050403 Aspen <strong>Dental</strong> 6416 Carlisle Pike, Suite 500 Mechanicsburg PA 17050 General Provider Cumberland<br />
Popernack John 000000050403 Aspen <strong>Dental</strong> 6416 Carlisle Pike, Suite 500 Mechanicsburg PA 17050 General Provider Cumberland<br />
Talati Ankit 000000050403 Aspen <strong>Dental</strong> 6416 Carlisle Pike, Suite 500 Mechanicsburg PA 17050 General Provider Cumberland<br />
Withanachchi Janatha Aspen <strong>Dental</strong> 6416 Carlisle Pike, Suite 500 Mechanicsburg PA 17050 Endodontist Cumberland<br />
Lahar Craig Craig E. Lahar, DMD OMS, P.C. 200 Cumberland Parkway Mechanicsburg PA 17055 Oral Surgeon Cumberland<br />
* Reese Terry 000000001476 Drs. Warren and Reese 324 E. Main Street Mechanicsburg PA 17055 General Provider Cumberland<br />
* Warren William 000000001476 Drs. Warren and Reese 324 E. Main Street Mechanicsburg PA 17055 General Provider Cumberland<br />
Patel Prafulchandra 000000050512 American <strong>Dental</strong> Care LLC 4811 Jonestown Rd, Suite 129 Harrisburg PA 17109 General Provider Dauphin<br />
Parikh Yogeshi 000000002773 Uptown Family <strong>Dentist</strong>ry 2626 N 3rd Street, Suite3C Harrisburg PA 17110 General Provider Dauphin<br />
Ramos Jesus 000000002773 Uptown Family <strong>Dentist</strong>ry 2626 N 3rd Street, Suite3C Harrisburg PA 17110 General Provider Dauphin<br />
Babameto Blendi Aspen <strong>Dental</strong> Associates of NY, PC 4265 Union Deposit Rd. Harrisburg PA 17111 Oral Surgeon Dauphin<br />
Butler Deborah 000000002749 Aspen <strong>Dental</strong> Associates of NY, PC 4265 Union Deposit Rd. Harrisburg PA 17111 General Provider Dauphin<br />
Ciarallo Robert Aspen <strong>Dental</strong> Associates of NY, PC 4265 Union Deposit Rd. Harrisburg PA 17111 Oral Surgeon Dauphin<br />
Desai Jagruti 000000002749 Aspen <strong>Dental</strong> Associates of NY, PC 4265 Union Deposit Rd. Harrisburg PA 17111 General Provider Dauphin<br />
Kaur Kamaljit 000000002749 Aspen <strong>Dental</strong> Associates of NY, PC 4265 Union Deposit Rd. Harrisburg PA 17111 General Provider Dauphin<br />
Kuleva Juliana 000000002749 Aspen <strong>Dental</strong> Associates of NY, PC 4265 Union Deposit Rd. Harrisburg PA 17111 General Provider Dauphin<br />
Popernack John 000000002749 Aspen <strong>Dental</strong> Associates of NY, PC 4265 Union Deposit Rd. Harrisburg PA 17111 General Provider Dauphin<br />
Talati Ankit 000000002749 Aspen <strong>Dental</strong> Associates of NY, PC 4265 Union Deposit Rd. Harrisburg PA 17111 General Provider Dauphin<br />
Withanachchi Janatha Aspen <strong>Dental</strong> Associates of NY, PC 4265 Union Deposit Rd. Harrisburg PA 17111 Endodontist Dauphin<br />
Watson John 000000001346 John J. Watson, D.D.S. 4707 Derry St. Harrisburg PA 17111 General Provider Dauphin<br />
Wojdylak Michael 000000000982 Michael Wojdylak, D.D.S. 61 Roosevelt Blvd, Suite 4 Harrisburg PA 17111 General Provider Dauphin<br />
Yoffe John John A. Yoffe, D.M.D. 2213 Forest Hills Drive Harrisburg PA 17112 Orthodontist Dauphin<br />
Dinello Donald Mid-Penn Oral Surgery 2201 Dover Rd Harrisburg PA 17112 Oral Surgeon Dauphin<br />
Rajchel Jeffrey Mid-Penn Oral Surgery 2201 Dover Rd Harrisburg PA 17112 Oral Surgeon Dauphin<br />
Patel Prafulchandra 000000001905 American <strong>Dental</strong> Care, L.L.C. 1135 E Chocolate Ave, Suite 101 Hershey PA 17033 General Provider Dauphin<br />
Patel Bhargav 000000069972 Hershey <strong>Dental</strong> Care 555 E Chocolate Ave Hershey PA 17033 General Provider Dauphin<br />
Jackson Carl 000000001528 Aston Family <strong>Dental</strong> Care 3200 Concord Rd., Ste.200 Aston PA 19014 General Provider Delaware<br />
Smith Alan 000000000840 Alan Jeffrey Smith, D.M.D. 130 E. Brookhaven Rd. Brookhaven PA 19015 General Provider Delaware<br />
Tewari Dinesh 000000069538 Brookhaven Family <strong>Dentist</strong>ry 4 W Brookhaven Rd Brookhaven PA 19015 General Provider Delaware<br />
Panossian Antoine A+ Oral Surgery Specialty Care PC 8 Ponds Edge Dr, Suite 2 Chadds Ford PA 19317 Oral Surgeon Delaware<br />
Bandelac Georges A+ Periodontic Specialty Care PC 8 Ponds Edge Dr, Suite 2 Chadds Ford PA 19317 Periodontist Delaware<br />
Evans Marianna A+ Periodontic Specialty Care PC 8 Ponds Edge Dr, Suite 2 Chadds Ford PA 19317 Periodontist Delaware<br />
Agrawal Avanti 000000002356 Advanced Family <strong>Dentist</strong>ry PC 8 Pond's Edge Drive, Suite 2 Chadds Ford PA 19317 General Provider Delaware<br />
Ahmadzadeh Bijan 000000002356 Advanced Family <strong>Dentist</strong>ry PC 8 Pond's Edge Drive, Suite 2 Chadds Ford PA 19317 General Provider Delaware<br />
Cho Woohyun 000000002356 Advanced Family <strong>Dentist</strong>ry PC 8 Pond's Edge Drive, Suite 2 Chadds Ford PA 19317 General Provider Delaware<br />
Dapkute Ingrida 000000002356 Advanced Family <strong>Dentist</strong>ry PC 8 Pond's Edge Drive, Suite 2 Chadds Ford PA 19317 General Provider Delaware<br />
Derosa Daniel 000000002356 Advanced Family <strong>Dentist</strong>ry PC 8 Pond's Edge Drive, Suite 2 Chadds Ford PA 19317 General Provider Delaware<br />
Gobron Adina 000000002356 Advanced Family <strong>Dentist</strong>ry PC 8 Pond's Edge Drive, Suite 2 Chadds Ford PA 19317 General Provider Delaware<br />
Lee Young 000000002356 Advanced Family <strong>Dentist</strong>ry PC 8 Pond's Edge Drive, Suite 2 Chadds Ford PA 19317 General Provider Delaware<br />
Merin Jared 000000002356 Advanced Family <strong>Dentist</strong>ry PC 8 Pond's Edge Drive, Suite 2 Chadds Ford PA 19317 General Provider Delaware<br />
Mitelman Alexandra 000000002356 Advanced Family <strong>Dentist</strong>ry PC 8 Pond's Edge Drive, Suite 2 Chadds Ford PA 19317 General Provider Delaware<br />
Moriarty Sean 000000002356 Advanced Family <strong>Dentist</strong>ry PC 8 Pond's Edge Drive, Suite 2 Chadds Ford PA 19317 General Provider Delaware<br />
Savani Bhaskar 000000002356 Advanced Family <strong>Dentist</strong>ry PC 8 Pond's Edge Drive, Suite 2 Chadds Ford PA 19317 General Provider Delaware<br />
Savani Niranjan 000000002356 Advanced Family <strong>Dentist</strong>ry PC 8 Pond's Edge Drive, Suite 2 Chadds Ford PA 19317 General Provider Delaware<br />
Singh Jagdeep 000000002356 Advanced Family <strong>Dentist</strong>ry PC 8 Pond's Edge Drive, Suite 2 Chadds Ford PA 19317 General Provider Delaware<br />
Todd Meredith 000000002356 Advanced Family <strong>Dentist</strong>ry PC 8 Pond's Edge Drive, Suite 2 Chadds Ford PA 19317 General Provider Delaware<br />
Yoon Jaewon 000000002356 Advanced Family <strong>Dentist</strong>ry PC 8 Pond's Edge Drive, Suite 2 Chadds Ford PA 19317 General Provider Delaware<br />
Turk Albert 000000001446 Albert Turk, D.M.D 127 Wilmington West, Chester Pike Chadds Ford PA 19317 General Provider Delaware<br />
Evans Marianna Allied Orthodontics PC 8 Ponds Edge Dr, Suite 2 Chadds Ford PA 19317 Orthodontist Delaware<br />
Barboza Maria Helena 000000033848 Centre for Cosmetic <strong>Dentist</strong>ry 275 Wilmington Westchester Pk, Ste. 111 Chadds Ford PA 19317 General Provider Delaware<br />
Hayes Richard Orthodontic Associates 3920 Pyle Road Chadds Ford PA 19317 Orthodontist Delaware<br />
DePanicis Vincent 000000002003 ChesPenn Health <strong>Services</strong> 125 E 9th Street Chester PA 19013 General Provider Delaware<br />
DePanicis Vincent 000000002004 ChesPenn Health <strong>Services</strong> 2602 West 9th Street Chester PA 19013 General Provider Delaware<br />
Kane Michael 000000002003 ChesPenn Health <strong>Services</strong> 125 E 9th Street Chester PA 19013 General Provider Delaware<br />
Kane Michael 000000002004 ChesPenn Health <strong>Services</strong> 2602 West 9th Street Chester PA 19013 General Provider Delaware<br />
Koshetar Nancy 000000002003 ChesPenn Health <strong>Services</strong> 125 E 9th Street Chester PA 19013 General Provider Delaware<br />
Koshetar Nancy 000000002004 ChesPenn Health <strong>Services</strong> 2602 West 9th Street Chester PA 19013 General Provider Delaware<br />
Tran Alyssa Dieu Tra 000000002003 ChesPenn Health <strong>Services</strong> 125 E 9th Street Chester PA 19013 General Provider Delaware<br />
Tran Alyssa Dieu Tra 000000002004 ChesPenn Health <strong>Services</strong> 2602 West 9th Street Chester PA 19013 General Provider Delaware<br />
Belkin Philip 000000001453 The Saltz <strong>Dental</strong> Center 616 Avenue of the States Chester PA 19013 General Provider Delaware<br />
Cooper Howard 000000001453 The Saltz <strong>Dental</strong> Center 616 Avenue of the States Chester PA 19013 General Provider Delaware<br />
Dhruva Ashvinskumar 000000001453 The Saltz <strong>Dental</strong> Center 616 Avenue of the States Chester PA 19013 General Provider Delaware<br />
Marinchak Michael 000000001453 The Saltz <strong>Dental</strong> Center 616 Avenue of the States Chester PA 19013 General Provider Delaware<br />
Sanfacon Dennis 000000001453 The Saltz <strong>Dental</strong> Center 616 Avenue of the States Chester PA 19013 General Provider Delaware<br />
Spevak Joseph 000000001453 The Saltz <strong>Dental</strong> Center 616 Avenue of the States Chester PA 19013 General Provider Delaware<br />
Bahram Ramin Oral Surgery Consultants of PA 151 South Springfield Road Clifton Heights PA 19018 Oral Surgeon Delaware<br />
* Indicates dentist that is accepting current patients only.<br />
All <strong>Select</strong> <strong>Plan</strong> <strong>Dentist</strong>s Page 21<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 <strong>Dentist</strong>. Fac ID is used to indicate which facility a member chooses.
SELECT PLAN 1 DENTIST DIRECTORY<br />
<strong>Dentist</strong>s listed are under contract as of 9/1/12<br />
Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />
Bowser Daniel Oral Surgery Consultants of PA 151 South Springfield Road Clifton Heights PA 19018 Oral Surgeon Delaware<br />
Richman Brad Oral Surgery Consultants of PA 151 South Springfield Road Clifton Heights PA 19018 Oral Surgeon Delaware<br />
Kabil Abdallah 000000002127 Hollyland <strong>Dental</strong> Center 917 MacDade Blvd Collingdale PA 19023 General Provider Delaware<br />
Clark Tanner 000000015469 Ameri <strong>Dental</strong> Group PC 875 Main Street Darby PA 19023 General Provider Delaware<br />
Patel Amish 000000015469 Ameri <strong>Dental</strong> Group PC 875 Main Street Darby PA 19023 General Provider Delaware<br />
Patel Prafulchandra 000000015469 Ameri <strong>Dental</strong> Group PC 875 Main Street Darby PA 19023 General Provider Delaware<br />
Tewari Dinesh 000000069540 Drexel Hill Family <strong>Dentist</strong>ry PC 4244 Ferne Blvd Drexel Hill PA 19026 General Provider Delaware<br />
Kaye Melvin Melvin A Kaye DDS 2237 Garrett Rd. Drexel Hill PA 19026 Endodontist Delaware<br />
Bahram Ramin Oral Surgery Consultants of PA 720 Macdade Boulevard Folsom PA 19033 Oral Surgeon Delaware<br />
Bowser Daniel Oral Surgery Consultants of PA 720 Macdade Boulevard Folsom PA 19033 Oral Surgeon Delaware<br />
Richman Brad Oral Surgery Consultants of PA 720 Macdade Boulevard Folsom PA 19033 Oral Surgeon Delaware<br />
Mongiovi Vincent Mongiovi Orthodontics 4 Woodland Drive Glen Mills PA 19342 Orthodontist Delaware<br />
Wank Harvey Harvey A. Wank, D.M.D. 525 West Chester Pike, Suite 100 Havertown PA 19083 Oral Surgeon Delaware<br />
Shafagh Iraj 000000001320 Iraj Shafagh, D.M.D. 109 North Eagle Rd. Havertown PA 19083 General Provider Delaware<br />
Mostatab Rebecca 000000002140 Smile By Design 1330 W Chester Pike Havertown PA 19083 General Provider Delaware<br />
Cooper Joel 000000000992 Ameri <strong>Dental</strong> Group PC 43 S Lansdowne Ave. Lansdowne PA 19050 General Provider Delaware<br />
Patel Amish 000000000992 Ameri <strong>Dental</strong> Group PC 43 S Lansdowne Ave. Lansdowne PA 19050 General Provider Delaware<br />
Patel Prafulchandra 000000000992 Ameri <strong>Dental</strong> Group PC 43 S Lansdowne Ave. Lansdowne PA 19050 General Provider Delaware<br />
Adams Michael 000000002801 American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 General Provider Delaware<br />
Blumenthal Edan 000000002801 American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 General Provider Delaware<br />
Blumenthal Mitchel 000000002801 American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 General Provider Delaware<br />
Bruno Frank American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 Endodontist Delaware<br />
Chen Yang 000000002801 American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 General Provider Delaware<br />
Cohen Hal 000000002801 American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 General Provider Delaware<br />
Daly Gerald 000000002801 American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 General Provider Delaware<br />
David Dan 000000002801 American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 General Provider Delaware<br />
Edmonds R Blake 000000002801 American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 General Provider Delaware<br />
Elkhatib Mohammad 000000002801 American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 General Provider Delaware<br />
Fluhr Howard 000000002801 American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 General Provider Delaware<br />
Gelbart Steven 000000002801 American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 General Provider Delaware<br />
Gilkey William 000000002801 American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 General Provider Delaware<br />
Khan Aliya 000000002801 American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 General Provider Delaware<br />
Kim Jae Woo 000000002801 American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 General Provider Delaware<br />
Kim Steven American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 Periodontist Delaware<br />
Koff Howard American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 Orthodontist Delaware<br />
Levy Jamie American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 Oral Surgeon Delaware<br />
Li Fuming 000000002801 American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 General Provider Delaware<br />
Lu John American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 Periodontist Delaware<br />
Mojahed Amir 000000002801 American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 General Provider Delaware<br />
Mumtaz Samera 000000002801 American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 General Provider Delaware<br />
Nguyen Diep 000000002801 American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 General Provider Delaware<br />
Oh Jinsuk 000000002801 American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 General Provider Delaware<br />
Parakhoodi Shabnam 000000002801 American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 General Provider Delaware<br />
Pereia Christine 000000002801 American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 General Provider Delaware<br />
Roth Michael American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 Orthodontist Delaware<br />
Ruggieri John 000000002801 American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 General Provider Delaware<br />
Sacks Frederick American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 Oral Surgeon Delaware<br />
Sandhu Satinder 000000002801 American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 General Provider Delaware<br />
Sanfacon Dennis 000000002801 American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 General Provider Delaware<br />
Shah Nishit 000000002801 American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 General Provider Delaware<br />
Sultana Parveen 000000002801 American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 General Provider Delaware<br />
Thilak Preetha 000000002801 American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 General Provider Delaware<br />
Weinstein Steven 000000002801 American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 General Provider Delaware<br />
Yang Qing 000000002801 American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 General Provider Delaware<br />
Yao Zheng 000000002801 American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 General Provider Delaware<br />
Yoon Simon 000000002801 American <strong>Dental</strong> Care, PC 1003 W Baltimore Pike Media PA 19063 General Provider Delaware<br />
Bresler David David A Bresler DDS PC 1003 West Baltimore Pike Media PA 19063 Pedodontist Delaware<br />
Bresler Jason David A Bresler DDS PC 1003 West Baltimore Pike Media PA 19063 Pedodontist Delaware<br />
Bresler Joshua David A Bresler DDS PC 1003 West Baltimore Pike Media PA 19063 Pedodontist Delaware<br />
Mayzenberg Julia David A Bresler DDS PC 1003 West Baltimore Pike Media PA 19063 Pedodontist Delaware<br />
Kahlon Sonia Rich Family Orthodontics 1022 E Baltimore Pike Media PA 19063 Orthodontist Delaware<br />
Rich Jeremy Rich Family Orthodontics 1022 E Baltimore Pike Media PA 19063 Orthodontist Delaware<br />
Panossian Antoine A+ Oral Surgery Specialty Care PC 35 B Woodland Ave Morton PA 19070 Oral Surgeon Delaware<br />
Bandelac Georges A+ Periodontic Specialty Care PC 35 B Woodland Ave Morton PA 19070 Periodontist Delaware<br />
Evans Marianna A+ Periodontic Specialty Care PC 35 B Woodland Ave Morton PA 19070 Periodontist Delaware<br />
Agrawal Avanti 000000002354 Advanced Family <strong>Dentist</strong>ry PC 35 B Woodland Avenue Morton PA 19070 General Provider Delaware<br />
* Indicates dentist that is accepting current patients only.<br />
All <strong>Select</strong> <strong>Plan</strong> <strong>Dentist</strong>s Page 22<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 <strong>Dentist</strong>. Fac ID is used to indicate which facility a member chooses.
SELECT PLAN 1 DENTIST DIRECTORY<br />
<strong>Dentist</strong>s listed are under contract as of 9/1/12<br />
Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />
Ahmadzadeh Bijan 000000002354 Advanced Family <strong>Dentist</strong>ry PC 35 B Woodland Avenue Morton PA 19070 General Provider Delaware<br />
Dapkute Ingrida 000000002354 Advanced Family <strong>Dentist</strong>ry PC 35 B Woodland Avenue Morton PA 19070 General Provider Delaware<br />
Derosa Daniel 000000002354 Advanced Family <strong>Dentist</strong>ry PC 35 B Woodland Avenue Morton PA 19070 General Provider Delaware<br />
Gobron Adina 000000002354 Advanced Family <strong>Dentist</strong>ry PC 35 B Woodland Avenue Morton PA 19070 General Provider Delaware<br />
Merin Jared 000000002354 Advanced Family <strong>Dentist</strong>ry PC 35 B Woodland Avenue Morton PA 19070 General Provider Delaware<br />
Mitelman Alexandra 000000002354 Advanced Family <strong>Dentist</strong>ry PC 35 B Woodland Avenue Morton PA 19070 General Provider Delaware<br />
Moriarty Sean 000000002354 Advanced Family <strong>Dentist</strong>ry PC 35 B Woodland Avenue Morton PA 19070 General Provider Delaware<br />
Savani Bhaskar 000000002354 Advanced Family <strong>Dentist</strong>ry PC 35 B Woodland Avenue Morton PA 19070 General Provider Delaware<br />
Savani Niranjan 000000002354 Advanced Family <strong>Dentist</strong>ry PC 35 B Woodland Avenue Morton PA 19070 General Provider Delaware<br />
Sitkovetsky Mikhail 000000002354 Advanced Family <strong>Dentist</strong>ry PC 35 B Woodland Avenue Morton PA 19070 General Provider Delaware<br />
Srivastava Rani 000000002354 Advanced Family <strong>Dentist</strong>ry PC 35 B Woodland Avenue Morton PA 19070 General Provider Delaware<br />
Todd Meredith 000000002354 Advanced Family <strong>Dentist</strong>ry PC 35 B Woodland Avenue Morton PA 19070 General Provider Delaware<br />
Wang Lin 000000002354 Advanced Family <strong>Dentist</strong>ry PC 35 B Woodland Avenue Morton PA 19070 General Provider Delaware<br />
Bresler David Doc Breslers Cavity Busters 4659 West Chester Pike Newtown Square PA 19073 Pedodontist Delaware<br />
Bresler Jason Doc Breslers Cavity Busters 4659 West Chester Pike Newtown Square PA 19073 Pedodontist Delaware<br />
Bresler Joshua Doc Breslers Cavity Busters 4659 West Chester Pike Newtown Square PA 19073 Pedodontist Delaware<br />
Mayzenberg Julia Doc Breslers Cavity Busters 4659 West Chester Pike Newtown Square PA 19073 Pedodontist Delaware<br />
Zito Domenico Domenico Zito, D.M.D. Newton Towers, 3400 W. Chester Pke. Ste. 850 Newtown Square PA 19073 Periodontist Delaware<br />
Dow Najibe 000000069534 Najibe H Dow DMD Family <strong>Dentist</strong>ry 3111 West Chester Pike Newtown Square PA 19073 General Provider Delaware<br />
Tewari Dinesh 000000069539 Norwood Family <strong>Dentist</strong>ry 7 W Winona Ave Norwood PA 19074 General Provider Delaware<br />
Shore Jeffrey 000000000361 Shore & Snyder <strong>Dental</strong> Center 519 Chester Pike, Box 40 Norwood PA 19074 General Provider Delaware<br />
Snyder Mark 000000000361 Shore & Snyder <strong>Dental</strong> Center 519 Chester Pike, Box 40 Norwood PA 19074 General Provider Delaware<br />
Hayes Richard Orthodontic Associates 101 Dutton Street Ridley Park PA 19078 Orthodontist Delaware<br />
Adams Michael 000000002794 American <strong>Dental</strong> Care, PC 515 Baltimore Pike Springfield PA 19064 General Provider Delaware<br />
Bruno Frank American <strong>Dental</strong> Care, PC 515 Baltimore Pike Springfield PA 19064 Endodontist Delaware<br />
Chen Yang 000000002794 American <strong>Dental</strong> Care, PC 515 Baltimore Pike Springfield PA 19064 General Provider Delaware<br />
Cohen Hal 000000002794 American <strong>Dental</strong> Care, PC 515 Baltimore Pike Springfield PA 19064 General Provider Delaware<br />
Daly Gerald 000000002794 American <strong>Dental</strong> Care, PC 515 Baltimore Pike Springfield PA 19064 General Provider Delaware<br />
David Dan 000000002794 American <strong>Dental</strong> Care, PC 515 Baltimore Pike Springfield PA 19064 General Provider Delaware<br />
Edmonds R Blake 000000002794 American <strong>Dental</strong> Care, PC 515 Baltimore Pike Springfield PA 19064 General Provider Delaware<br />
Elkhatib Mohammad 000000002794 American <strong>Dental</strong> Care, PC 515 Baltimore Pike Springfield PA 19064 General Provider Delaware<br />
Fluhr Howard 000000002794 American <strong>Dental</strong> Care, PC 515 Baltimore Pike Springfield PA 19064 General Provider Delaware<br />
Gelbart Steven 000000002794 American <strong>Dental</strong> Care, PC 515 Baltimore Pike Springfield PA 19064 General Provider Delaware<br />
Kim Jae Woo 000000002794 American <strong>Dental</strong> Care, PC 515 Baltimore Pike Springfield PA 19064 General Provider Delaware<br />
Kim Steven American <strong>Dental</strong> Care, PC 515 Baltimore Pike Springfield PA 19064 Periodontist Delaware<br />
Koff Howard American <strong>Dental</strong> Care, PC 515 Baltimore Pike Springfield PA 19064 Orthodontist Delaware<br />
Levy Jamie American <strong>Dental</strong> Care, PC 515 Baltimore Pike Springfield PA 19064 Oral Surgeon Delaware<br />
Li Fuming 000000002794 American <strong>Dental</strong> Care, PC 515 Baltimore Pike Springfield PA 19064 General Provider Delaware<br />
Lu John American <strong>Dental</strong> Care, PC 515 Baltimore Pike Springfield PA 19064 Periodontist Delaware<br />
Mojahed Amir 000000002794 American <strong>Dental</strong> Care, PC 515 Baltimore Pike Springfield PA 19064 General Provider Delaware<br />
Mumtaz Samera 000000002794 American <strong>Dental</strong> Care, PC 515 Baltimore Pike Springfield PA 19064 General Provider Delaware<br />
Nguyen Diep 000000002794 American <strong>Dental</strong> Care, PC 515 Baltimore Pike Springfield PA 19064 General Provider Delaware<br />
Oh Jinsuk 000000002794 American <strong>Dental</strong> Care, PC 515 Baltimore Pike Springfield PA 19064 General Provider Delaware<br />
Pereia Christine 000000002794 American <strong>Dental</strong> Care, PC 515 Baltimore Pike Springfield PA 19064 General Provider Delaware<br />
Roth Michael American <strong>Dental</strong> Care, PC 515 Baltimore Pike Springfield PA 19064 Orthodontist Delaware<br />
Ruggieri John 000000002794 American <strong>Dental</strong> Care, PC 515 Baltimore Pike Springfield PA 19064 General Provider Delaware<br />
Sandhu Satinder 000000002794 American <strong>Dental</strong> Care, PC 515 Baltimore Pike Springfield PA 19064 General Provider Delaware<br />
Sanfacon Dennis 000000002794 American <strong>Dental</strong> Care, PC 515 Baltimore Pike Springfield PA 19064 General Provider Delaware<br />
Shah Nishit 000000002794 American <strong>Dental</strong> Care, PC 515 Baltimore Pike Springfield PA 19064 General Provider Delaware<br />
Sultana Parveen 000000002794 American <strong>Dental</strong> Care, PC 515 Baltimore Pike Springfield PA 19064 General Provider Delaware<br />
Thilak Preetha 000000002794 American <strong>Dental</strong> Care, PC 515 Baltimore Pike Springfield PA 19064 General Provider Delaware<br />
Weinstein Steven 000000002794 American <strong>Dental</strong> Care, PC 515 Baltimore Pike Springfield PA 19064 General Provider Delaware<br />
Yang Qing 000000002794 American <strong>Dental</strong> Care, PC 515 Baltimore Pike Springfield PA 19064 General Provider Delaware<br />
Yao Zheng 000000002794 American <strong>Dental</strong> Care, PC 515 Baltimore Pike Springfield PA 19064 General Provider Delaware<br />
Yoon Simon 000000002794 American <strong>Dental</strong> Care, PC 515 Baltimore Pike Springfield PA 19064 General Provider Delaware<br />
Hayes Richard Orthodontic Associates 1050 Baltimore Pike Springfield PA 19064 Orthodontist Delaware<br />
Adams Michael 000000002795 American <strong>Dental</strong> Care, PC 6780 Market Street Upper Darby PA 19082 General Provider Delaware<br />
Bruno Frank American <strong>Dental</strong> Care, PC 6780 Market Street Upper Darby PA 19082 Endodontist Delaware<br />
Chen Yang 000000002795 American <strong>Dental</strong> Care, PC 6780 Market Street Upper Darby PA 19082 General Provider Delaware<br />
Cohen Hal 000000002795 American <strong>Dental</strong> Care, PC 6780 Market Street Upper Darby PA 19082 General Provider Delaware<br />
Daly Gerald 000000002795 American <strong>Dental</strong> Care, PC 6780 Market Street Upper Darby PA 19082 General Provider Delaware<br />
David Dan 000000002795 American <strong>Dental</strong> Care, PC 6780 Market Street Upper Darby PA 19082 General Provider Delaware<br />
Edmonds R Blake 000000002795 American <strong>Dental</strong> Care, PC 6780 Market Street Upper Darby PA 19082 General Provider Delaware<br />
Elkhatib Mohammad 000000002795 American <strong>Dental</strong> Care, PC 6780 Market Street Upper Darby PA 19082 General Provider Delaware<br />
Fluhr Howard 000000002795 American <strong>Dental</strong> Care, PC 6780 Market Street Upper Darby PA 19082 General Provider Delaware<br />
Gelbart Steven 000000002795 American <strong>Dental</strong> Care, PC 6780 Market Street Upper Darby PA 19082 General Provider Delaware<br />
* Indicates dentist that is accepting current patients only.<br />
All <strong>Select</strong> <strong>Plan</strong> <strong>Dentist</strong>s Page 23<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 <strong>Dentist</strong>. Fac ID is used to indicate which facility a member chooses.
SELECT PLAN 1 DENTIST DIRECTORY<br />
<strong>Dentist</strong>s listed are under contract as of 9/1/12<br />
Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />
Kim Jae Woo 000000002795 American <strong>Dental</strong> Care, PC 6780 Market Street Upper Darby PA 19082 General Provider Delaware<br />
Kim Steven American <strong>Dental</strong> Care, PC 6780 Market Street Upper Darby PA 19082 Periodontist Delaware<br />
Koff Howard American <strong>Dental</strong> Care, PC 6780 Market Street Upper Darby PA 19082 Orthodontist Delaware<br />
Levy Jamie American <strong>Dental</strong> Care, PC 6780 Market Street Upper Darby PA 19082 Oral Surgeon Delaware<br />
Li Fuming 000000002795 American <strong>Dental</strong> Care, PC 6780 Market Street Upper Darby PA 19082 General Provider Delaware<br />
Lu John American <strong>Dental</strong> Care, PC 6780 Market Street Upper Darby PA 19082 Periodontist Delaware<br />
Mojahed Amir 000000002795 American <strong>Dental</strong> Care, PC 6780 Market Street Upper Darby PA 19082 General Provider Delaware<br />
Mumtaz Samera 000000002795 American <strong>Dental</strong> Care, PC 6780 Market Street Upper Darby PA 19082 General Provider Delaware<br />
Nguyen Diep 000000002795 American <strong>Dental</strong> Care, PC 6780 Market Street Upper Darby PA 19082 General Provider Delaware<br />
Oh Jinsuk 000000002795 American <strong>Dental</strong> Care, PC 6780 Market Street Upper Darby PA 19082 General Provider Delaware<br />
Pereia Christine 000000002795 American <strong>Dental</strong> Care, PC 6780 Market Street Upper Darby PA 19082 General Provider Delaware<br />
Roth Michael American <strong>Dental</strong> Care, PC 6780 Market Street Upper Darby PA 19082 Orthodontist Delaware<br />
Ruggieri John 000000002795 American <strong>Dental</strong> Care, PC 6780 Market Street Upper Darby PA 19082 General Provider Delaware<br />
Sandhu Satinder 000000002795 American <strong>Dental</strong> Care, PC 6780 Market Street Upper Darby PA 19082 General Provider Delaware<br />
Sanfacon Dennis 000000002795 American <strong>Dental</strong> Care, PC 6780 Market Street Upper Darby PA 19082 General Provider Delaware<br />
Shah Nishit 000000002795 American <strong>Dental</strong> Care, PC 6780 Market Street Upper Darby PA 19082 General Provider Delaware<br />
Sultana Parveen 000000002795 American <strong>Dental</strong> Care, PC 6780 Market Street Upper Darby PA 19082 General Provider Delaware<br />
Thilak Preetha 000000002795 American <strong>Dental</strong> Care, PC 6780 Market Street Upper Darby PA 19082 General Provider Delaware<br />
Yang Qing 000000002795 American <strong>Dental</strong> Care, PC 6780 Market Street Upper Darby PA 19082 General Provider Delaware<br />
Yao Zheng 000000002795 American <strong>Dental</strong> Care, PC 6780 Market Street Upper Darby PA 19082 General Provider Delaware<br />
Yoon Simon 000000002795 American <strong>Dental</strong> Care, PC 6780 Market Street Upper Darby PA 19082 General Provider Delaware<br />
Joseph Zacharias 000000038068 Care <strong>Dental</strong> LLC 134 S State Rd Upper Darby PA 19082 General Provider Delaware<br />
Brown Glen 000000000498 Glenn A Brown, DMD 6776 Market Street Upper Darby PA 19082 General Provider Delaware<br />
Aftab Kanwal 000000068496 Pristine <strong>Dental</strong> LLC 392 Avon Rd Upper Darby PA 19082 General Provider Delaware<br />
Aranbayev Yefim 000000068496 Pristine <strong>Dental</strong> LLC 392 Avon Rd Upper Darby PA 19082 General Provider Delaware<br />
Mallya Rachel 000000000831 Rachel Mallya, D.M.D. 27 Garrett Road Upper Darby PA 19082 General Provider Delaware<br />
Gross Stephanie S. Harris Gross Wallingford Perio Center 9 N. Providence Rd., P.O. Box 81 Wallingford PA 19086 Periodontist Delaware<br />
Mostatab Rebecca 000000002740 Smile By Design 335 West Lancaster Ave Wayne PA 19087 General Provider Delaware<br />
Dhillon Upinder 000000070447 Complete <strong>Dental</strong> Care 1300 Macdade Blvd, Suite 5 Woodlyn PA 19094 General Provider Delaware<br />
Tewari Dinesh 000000079079 Yeadon Family <strong>Dentist</strong>ry 724 Church Lane Yeadon PA 19050 General Provider Delaware<br />
Glecos Robert 000000037963 Aspen <strong>Dental</strong> Associates of NY., P.C. 2049 Interchange Rd Erie PA 16509 General Provider Erie<br />
Mohney Bryan 000000037963 Aspen <strong>Dental</strong> Associates of NY., P.C. 2049 Interchange Rd Erie PA 16509 General Provider Erie<br />
Aboosi Omar 000000002825 Aspen <strong>Dental</strong> of Western PA, PC 100 Pricedale Rd. Belle Vernon PA 15012 General Provider Fayette<br />
Bonczek Brian 000000002825 Aspen <strong>Dental</strong> of Western PA, PC 100 Pricedale Rd. Belle Vernon PA 15012 General Provider Fayette<br />
Ciarallo Robert Aspen <strong>Dental</strong> of Western PA, PC 100 Pricedale Rd. Belle Vernon PA 15012 Oral Surgeon Fayette<br />
Grinberg Anna 000000002825 Aspen <strong>Dental</strong> of Western PA, PC 100 Pricedale Rd. Belle Vernon PA 15012 General Provider Fayette<br />
Monaco Natalie 000000002825 Aspen <strong>Dental</strong> of Western PA, PC 100 Pricedale Rd. Belle Vernon PA 15012 General Provider Fayette<br />
Monios George 000000002825 Aspen <strong>Dental</strong> of Western PA, PC 100 Pricedale Rd. Belle Vernon PA 15012 General Provider Fayette<br />
Noel Rubins 000000002825 Aspen <strong>Dental</strong> of Western PA, PC 100 Pricedale Rd. Belle Vernon PA 15012 General Provider Fayette<br />
Ruprecht Heather 000000002825 Aspen <strong>Dental</strong> of Western PA, PC 100 Pricedale Rd. Belle Vernon PA 15012 General Provider Fayette<br />
Shieh Andy 000000002825 Aspen <strong>Dental</strong> of Western PA, PC 100 Pricedale Rd. Belle Vernon PA 15012 General Provider Fayette<br />
Gates Durwin 000000001649 Durwin L. Gates, D.M.D. 956 Rostraver Road Belle Vernon PA 15012 General Provider Fayette<br />
Barron, Jr Edward 000000050915 Edward L Barron Jr DDS PC 1730 Rostraver Rd, PO Box 926 Belle Vernon PA 15012 General Provider Fayette<br />
Balasubramaniam Ravi 000000001365 Laurel Highlands Family <strong>Dentist</strong>ry 1952 University Drive Connellsville PA 15425 General Provider Fayette<br />
McKee Jessica 000000050956 Cornerstone <strong>Inc</strong> 140 N Beeson Rd, Suite 400 Uniontown PA 15401 General Provider Fayette<br />
McKee Laura 000000050956 Cornerstone <strong>Inc</strong> 140 N Beeson Rd, Suite 400 Uniontown PA 15401 General Provider Fayette<br />
Howard-Stickel Brandi 000000001674 Cornerstone <strong>Inc</strong> 7 Glassworks Rd Greensboro PA 15338 General Provider Greene<br />
McKee Jessica 000000001674 Cornerstone <strong>Inc</strong> 7 Glassworks Rd Greensboro PA 15338 General Provider Greene<br />
McKee Laura 000000001674 Cornerstone <strong>Inc</strong> 7 Glassworks Rd Greensboro PA 15338 General Provider Greene<br />
Montgomery R Gregory 000000001674 Cornerstone <strong>Inc</strong> 7 Glassworks Rd Greensboro PA 15338 General Provider Greene<br />
Wilt Rachel 000000001674 Cornerstone <strong>Inc</strong> 7 Glassworks Rd Greensboro PA 15338 General Provider Greene<br />
Lewis Amy 000000050955 Cornerstone <strong>Inc</strong> Mobile Unit 7 Glassworks Rd. Greensboro PA 15338 General Provider Greene<br />
Martin Jarrell 000000050955 Cornerstone <strong>Inc</strong> Mobile Unit 7 Glassworks Rd. Greensboro PA 15338 General Provider Greene<br />
McKee Jessica 000000050955 Cornerstone <strong>Inc</strong> Mobile Unit 7 Glassworks Rd. Greensboro PA 15338 General Provider Greene<br />
McKee Laura 000000050955 Cornerstone <strong>Inc</strong> Mobile Unit 7 Glassworks Rd. Greensboro PA 15338 General Provider Greene<br />
Petrilla Gregory 000000050924 Primary Health Network/Indiana <strong>Dental</strong> Center 590 Indian Springs Rd Indiana PA 15701 General Provider Indiana<br />
Reed John 000000050924 Primary Health Network/Indiana <strong>Dental</strong> Center 590 Indian Springs Rd Indiana PA 15701 General Provider Indiana<br />
Attri Neellam 000000002096 Aspen <strong>Dental</strong> Associates of NE PA PC 1516 Scranton - Carbondale Hwy Scranton PA 18508 General Provider Lackawanna<br />
Babameto Blendi Aspen <strong>Dental</strong> Associates of NE PA PC 1516 Scranton - Carbondale Hwy Scranton PA 18508 Oral Surgeon Lackawanna<br />
Bannenahally Shruthi 000000002096 Aspen <strong>Dental</strong> Associates of NE PA PC 1516 Scranton - Carbondale Hwy Scranton PA 18508 General Provider Lackawanna<br />
Botros Samuel 000000002096 Aspen <strong>Dental</strong> Associates of NE PA PC 1516 Scranton - Carbondale Hwy Scranton PA 18508 General Provider Lackawanna<br />
Chandalada Agastayya 000000002096 Aspen <strong>Dental</strong> Associates of NE PA PC 1516 Scranton - Carbondale Hwy Scranton PA 18508 General Provider Lackawanna<br />
Chaudhry Ahmad 000000002096 Aspen <strong>Dental</strong> Associates of NE PA PC 1516 Scranton - Carbondale Hwy Scranton PA 18508 General Provider Lackawanna<br />
Gupta Shekhar 000000002096 Aspen <strong>Dental</strong> Associates of NE PA PC 1516 Scranton - Carbondale Hwy Scranton PA 18508 General Provider Lackawanna<br />
Harris Chad 000000002096 Aspen <strong>Dental</strong> Associates of NE PA PC 1516 Scranton - Carbondale Hwy Scranton PA 18508 General Provider Lackawanna<br />
Hu Yu Hui 000000002096 Aspen <strong>Dental</strong> Associates of NE PA PC 1516 Scranton - Carbondale Hwy Scranton PA 18508 General Provider Lackawanna<br />
* Indicates dentist that is accepting current patients only.<br />
All <strong>Select</strong> <strong>Plan</strong> <strong>Dentist</strong>s Page 24<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 <strong>Dentist</strong>. Fac ID is used to indicate which facility a member chooses.
SELECT PLAN 1 DENTIST DIRECTORY<br />
<strong>Dentist</strong>s listed are under contract as of 9/1/12<br />
Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />
Kunam Ramya 000000002096 Aspen <strong>Dental</strong> Associates of NE PA PC 1516 Scranton - Carbondale Hwy Scranton PA 18508 General Provider Lackawanna<br />
Mercado Conchita 000000002096 Aspen <strong>Dental</strong> Associates of NE PA PC 1516 Scranton - Carbondale Hwy Scranton PA 18508 General Provider Lackawanna<br />
Patel Udaykumar 000000002096 Aspen <strong>Dental</strong> Associates of NE PA PC 1516 Scranton - Carbondale Hwy Scranton PA 18508 General Provider Lackawanna<br />
Pham Thuy 000000002096 Aspen <strong>Dental</strong> Associates of NE PA PC 1516 Scranton - Carbondale Hwy Scranton PA 18508 General Provider Lackawanna<br />
Prasad Neralagadde 000000002096 Aspen <strong>Dental</strong> Associates of NE PA PC 1516 Scranton - Carbondale Hwy Scranton PA 18508 General Provider Lackawanna<br />
Tran Joshua 000000002096 Aspen <strong>Dental</strong> Associates of NE PA PC 1516 Scranton - Carbondale Hwy Scranton PA 18508 General Provider Lackawanna<br />
Williams Christopher 000000002096 Aspen <strong>Dental</strong> Associates of NE PA PC 1516 Scranton - Carbondale Hwy Scranton PA 18508 General Provider Lackawanna<br />
Withanachchi Janatha Aspen <strong>Dental</strong> Associates of NE PA PC 1516 Scranton - Carbondale Hwy Scranton PA 18508 Endodontist Lackawanna<br />
Babameto Blendi Aspen <strong>Dental</strong> Associates NE PA PLLC 1954 Fruitville Pike Lancaster PA 17601 Oral Surgeon Lancaster<br />
Botros Samuel 000000033853 Aspen <strong>Dental</strong> Associates NE PA PLLC 1954 Fruitville Pike Lancaster PA 17601 General Provider Lancaster<br />
Chandalada Agastayya 000000033853 Aspen <strong>Dental</strong> Associates NE PA PLLC 1954 Fruitville Pike Lancaster PA 17601 General Provider Lancaster<br />
Chaudhry Ahmad 000000033853 Aspen <strong>Dental</strong> Associates NE PA PLLC 1954 Fruitville Pike Lancaster PA 17601 General Provider Lancaster<br />
Gupta Shekhar 000000033853 Aspen <strong>Dental</strong> Associates NE PA PLLC 1954 Fruitville Pike Lancaster PA 17601 General Provider Lancaster<br />
Hamati Isam 000000033853 Aspen <strong>Dental</strong> Associates NE PA PLLC 1954 Fruitville Pike Lancaster PA 17601 General Provider Lancaster<br />
Hu Yu Hui 000000033853 Aspen <strong>Dental</strong> Associates NE PA PLLC 1954 Fruitville Pike Lancaster PA 17601 General Provider Lancaster<br />
Kunam Ramya 000000033853 Aspen <strong>Dental</strong> Associates NE PA PLLC 1954 Fruitville Pike Lancaster PA 17601 General Provider Lancaster<br />
Mercado Conchita 000000033853 Aspen <strong>Dental</strong> Associates NE PA PLLC 1954 Fruitville Pike Lancaster PA 17601 General Provider Lancaster<br />
Pham Thuy 000000033853 Aspen <strong>Dental</strong> Associates NE PA PLLC 1954 Fruitville Pike Lancaster PA 17601 General Provider Lancaster<br />
Prasad Neralagadde 000000033853 Aspen <strong>Dental</strong> Associates NE PA PLLC 1954 Fruitville Pike Lancaster PA 17601 General Provider Lancaster<br />
Tran Joshua 000000033853 Aspen <strong>Dental</strong> Associates NE PA PLLC 1954 Fruitville Pike Lancaster PA 17601 General Provider Lancaster<br />
Williams Christopher 000000033853 Aspen <strong>Dental</strong> Associates NE PA PLLC 1954 Fruitville Pike Lancaster PA 17601 General Provider Lancaster<br />
Withanachchi Janatha Aspen <strong>Dental</strong> Associates NE PA PLLC 1954 Fruitville Pike Lancaster PA 17601 Endodontist Lancaster<br />
* Strause Roger 000000001341 Centerville Family <strong>Dental</strong> 803 Estelle Dr. Lancaster PA 17601 General Provider Lancaster<br />
O'Donnell Daniel 000000001720 O'Donnell & Phillips LLC 230 Harrisburg Ave., Suite 5 Lancaster PA 17603 General Provider Lancaster<br />
Phillips Jason 000000001720 O'Donnell & Phillips LLC 230 Harrisburg Ave., Suite 5 Lancaster PA 17603 General Provider Lancaster<br />
Evans Marianna Allied Orthodontics PC 1555 Highlands Dr, Suite 190 Lititz PA 17543 Orthodontist Lancaster<br />
Ahmadzadeh Bijan 000000050977 American Family <strong>Dental</strong> Care PC 1555 Highlands Dr, Suite190 Lititz PA 17543 General Provider Lancaster<br />
Gobron Adina 000000050977 American Family <strong>Dental</strong> Care PC 1555 Highlands Dr, Suite190 Lititz PA 17543 General Provider Lancaster<br />
Lam Everest 000000050977 American Family <strong>Dental</strong> Care PC 1555 Highlands Dr, Suite190 Lititz PA 17543 General Provider Lancaster<br />
Moriarty Sean 000000050977 American Family <strong>Dental</strong> Care PC 1555 Highlands Dr, Suite190 Lititz PA 17543 General Provider Lancaster<br />
Savani Bhaskar 000000050977 American Family <strong>Dental</strong> Care PC 1555 Highlands Dr, Suite190 Lititz PA 17543 General Provider Lancaster<br />
Savani Niranjan 000000050977 American Family <strong>Dental</strong> Care PC 1555 Highlands Dr, Suite190 Lititz PA 17543 General Provider Lancaster<br />
* Paige James 000000001482 James R. Paige, D.D.S. 802 W. Washington Street New Castle PA 16101 General Provider Lawrence<br />
Beal Rhonda 000000001613 Primary Health Network/New Castle <strong>Dental</strong> Center 2807 Wilmington Rd New Castle PA 16105 General Provider Lawrence<br />
Cole Duane 000000001613 Primary Health Network/New Castle <strong>Dental</strong> Center 2807 Wilmington Rd New Castle PA 16105 General Provider Lawrence<br />
Cosgrove William 000000001613 Primary Health Network/New Castle <strong>Dental</strong> Center 2807 Wilmington Rd New Castle PA 16105 General Provider Lawrence<br />
Hartle Sheila 000000001613 Primary Health Network/New Castle <strong>Dental</strong> Center 2807 Wilmington Rd New Castle PA 16105 General Provider Lawrence<br />
Petrilla Gregory 000000001613 Primary Health Network/New Castle <strong>Dental</strong> Center 2807 Wilmington Rd New Castle PA 16105 General Provider Lawrence<br />
Reed John 000000001613 Primary Health Network/New Castle <strong>Dental</strong> Center 2807 Wilmington Rd New Castle PA 16105 General Provider Lawrence<br />
Bui Loc 000000001343 Mimosa Family <strong>Dentist</strong>ry, P.C. 117 W. Cherry St. Palmyra PA 17078 General Provider Lebanon<br />
Bui Toan 000000001343 Mimosa Family <strong>Dentist</strong>ry, P.C. 117 W. Cherry St. Palmyra PA 17078 General Provider Lebanon<br />
Bandelac Georges A+ Periodontic Specialty Care PC 1247 S Cedar Crest Blvd, Suite 300 Allentown PA 18103 Periodontist Lehigh<br />
Evans Marianna A+ Periodontic Specialty Care PC 1247 S Cedar Crest Blvd, Suite 300 Allentown PA 18103 Periodontist Lehigh<br />
Evans Marianna Allied Orthodontics PC 1247 S Cedar Crest Blvd, Suite 300 Allentown PA 18103 Orthodontist Lehigh<br />
Bhatnagar Payal 000000002358 Aspen <strong>Dental</strong> Associates of NY., P.C. 319 South Cedar Creek Blvd. Allentown PA 18103 General Provider Lehigh<br />
Chadha Chandan 000000002358 Aspen <strong>Dental</strong> Associates of NY., P.C. 319 South Cedar Creek Blvd. Allentown PA 18103 General Provider Lehigh<br />
Chaudhry Ahmad 000000002358 Aspen <strong>Dental</strong> Associates of NY., P.C. 319 South Cedar Creek Blvd. Allentown PA 18103 General Provider Lehigh<br />
Kim Peter 000000002358 Aspen <strong>Dental</strong> Associates of NY., P.C. 319 South Cedar Creek Blvd. Allentown PA 18103 General Provider Lehigh<br />
Malhotra Swati 000000002358 Aspen <strong>Dental</strong> Associates of NY., P.C. 319 South Cedar Creek Blvd. Allentown PA 18103 General Provider Lehigh<br />
Obaid Michel 000000002358 Aspen <strong>Dental</strong> Associates of NY., P.C. 319 South Cedar Creek Blvd. Allentown PA 18103 General Provider Lehigh<br />
Rajput Bhumika 000000002358 Aspen <strong>Dental</strong> Associates of NY., P.C. 319 South Cedar Creek Blvd. Allentown PA 18103 General Provider Lehigh<br />
Sambaraju Haritha 000000002358 Aspen <strong>Dental</strong> Associates of NY., P.C. 319 South Cedar Creek Blvd. Allentown PA 18103 General Provider Lehigh<br />
Withanachchi Janatha Aspen <strong>Dental</strong> Associates of NY., P.C. 319 South Cedar Creek Blvd. Allentown PA 18103 Endodontist Lehigh<br />
Yi Tyler 000000002358 Aspen <strong>Dental</strong> Associates of NY., P.C. 319 South Cedar Creek Blvd. Allentown PA 18103 General Provider Lehigh<br />
Agrawal Avanti 000000051021 Smile Krafters PC 1247 S Cedar Crest Blvd, Suite 300 Allentown PA 18103 General Provider Lehigh<br />
Derosa Daniel 000000051021 Smile Krafters PC 1247 S Cedar Crest Blvd, Suite 300 Allentown PA 18103 General Provider Lehigh<br />
Dormeshian Andrew 000000051021 Smile Krafters PC 1247 S Cedar Crest Blvd, Suite 300 Allentown PA 18103 General Provider Lehigh<br />
Savani Bhaskar 000000051021 Smile Krafters PC 1247 S Cedar Crest Blvd, Suite 300 Allentown PA 18103 General Provider Lehigh<br />
Savani Niranjan 000000051021 Smile Krafters PC 1247 S Cedar Crest Blvd, Suite 300 Allentown PA 18103 General Provider Lehigh<br />
Todd Meredith 000000051021 Smile Krafters PC 1247 S Cedar Crest Blvd, Suite 300 Allentown PA 18103 General Provider Lehigh<br />
Panossian Antoine A+ Oral Surgery Specialty Care PC 1247 S Cedar Crest Blvd, Suite 300 Allentown PA 18104 Oral Surgeon Lehigh<br />
Ferguson Michele 000000000635 Gentle <strong>Dental</strong> Allentown LLC 2015 W Hamilton St., Suite 202 Allentown PA 18104 General Provider Lehigh<br />
Halpern Wendy Gentle <strong>Dental</strong> Allentown LLC 2015 W Hamilton St., Suite 202 Allentown PA 18104 Periodontist Lehigh<br />
Libou Keith 000000000635 Gentle <strong>Dental</strong> Allentown LLC 2015 W Hamilton St., Suite 202 Allentown PA 18104 General Provider Lehigh<br />
Minetola Mark 000000000635 Gentle <strong>Dental</strong> Allentown LLC 2015 W Hamilton St., Suite 202 Allentown PA 18104 General Provider Lehigh<br />
Samineni Neelima 000000000635 Gentle <strong>Dental</strong> Allentown LLC 2015 W Hamilton St., Suite 202 Allentown PA 18104 General Provider Lehigh<br />
* Indicates dentist that is accepting current patients only.<br />
All <strong>Select</strong> <strong>Plan</strong> <strong>Dentist</strong>s Page 25<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 <strong>Dentist</strong>. Fac ID is used to indicate which facility a member chooses.
SELECT PLAN 1 DENTIST DIRECTORY<br />
<strong>Dentist</strong>s listed are under contract as of 9/1/12<br />
Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />
Panossian Antoine A+ Oral Surgery Specialty Care PC 1901 Union Blvd Allentown PA 18109 Oral Surgeon Lehigh<br />
Bhatnagar Payal 000000038065 Aspen <strong>Dental</strong> 1856 Airport Rd Allentown PA 18109 General Provider Lehigh<br />
Chadha Chandan 000000038065 Aspen <strong>Dental</strong> 1856 Airport Rd Allentown PA 18109 General Provider Lehigh<br />
Chaudhry Ahmad 000000038065 Aspen <strong>Dental</strong> 1856 Airport Rd Allentown PA 18109 General Provider Lehigh<br />
Kim Peter 000000038065 Aspen <strong>Dental</strong> 1856 Airport Rd Allentown PA 18109 General Provider Lehigh<br />
Malhotra Swati 000000038065 Aspen <strong>Dental</strong> 1856 Airport Rd Allentown PA 18109 General Provider Lehigh<br />
Obaid Michel 000000038065 Aspen <strong>Dental</strong> 1856 Airport Rd Allentown PA 18109 General Provider Lehigh<br />
Rajput Bhumika 000000038065 Aspen <strong>Dental</strong> 1856 Airport Rd Allentown PA 18109 General Provider Lehigh<br />
Sambaraju Haritha 000000038065 Aspen <strong>Dental</strong> 1856 Airport Rd Allentown PA 18109 General Provider Lehigh<br />
Withanachchi Janatha Aspen <strong>Dental</strong> 1856 Airport Rd Allentown PA 18109 Endodontist Lehigh<br />
Yi Tyler 000000038065 Aspen <strong>Dental</strong> 1856 Airport Rd Allentown PA 18109 General Provider Lehigh<br />
Attri Neellam 000000002883 Aspen <strong>Dental</strong> Associates of NEPA, PLLC 741 Airport Rd. Hazle Township PA 18202 General Provider Luzerne<br />
Babameto Blendi Aspen <strong>Dental</strong> Associates of NEPA, PLLC 741 Airport Rd. Hazle Township PA 18202 Oral Surgeon Luzerne<br />
Bannenahally Shruthi 000000002883 Aspen <strong>Dental</strong> Associates of NEPA, PLLC 741 Airport Rd. Hazle Township PA 18202 General Provider Luzerne<br />
Botros Samuel 000000002883 Aspen <strong>Dental</strong> Associates of NEPA, PLLC 741 Airport Rd. Hazle Township PA 18202 General Provider Luzerne<br />
Chandalada Agastayya 000000002883 Aspen <strong>Dental</strong> Associates of NEPA, PLLC 741 Airport Rd. Hazle Township PA 18202 General Provider Luzerne<br />
Chaudhry Ahmad 000000002883 Aspen <strong>Dental</strong> Associates of NEPA, PLLC 741 Airport Rd. Hazle Township PA 18202 General Provider Luzerne<br />
Gupta Shekhar 000000002883 Aspen <strong>Dental</strong> Associates of NEPA, PLLC 741 Airport Rd. Hazle Township PA 18202 General Provider Luzerne<br />
Harris Chad 000000002883 Aspen <strong>Dental</strong> Associates of NEPA, PLLC 741 Airport Rd. Hazle Township PA 18202 General Provider Luzerne<br />
Hu Yu Hui 000000002883 Aspen <strong>Dental</strong> Associates of NEPA, PLLC 741 Airport Rd. Hazle Township PA 18202 General Provider Luzerne<br />
Kunam Ramya 000000002883 Aspen <strong>Dental</strong> Associates of NEPA, PLLC 741 Airport Rd. Hazle Township PA 18202 General Provider Luzerne<br />
Mercado Conchita 000000002883 Aspen <strong>Dental</strong> Associates of NEPA, PLLC 741 Airport Rd. Hazle Township PA 18202 General Provider Luzerne<br />
Patel Udaykumar 000000002883 Aspen <strong>Dental</strong> Associates of NEPA, PLLC 741 Airport Rd. Hazle Township PA 18202 General Provider Luzerne<br />
Pham Thuy 000000002883 Aspen <strong>Dental</strong> Associates of NEPA, PLLC 741 Airport Rd. Hazle Township PA 18202 General Provider Luzerne<br />
Prasad Neralagadde 000000002883 Aspen <strong>Dental</strong> Associates of NEPA, PLLC 741 Airport Rd. Hazle Township PA 18202 General Provider Luzerne<br />
Sambaraju Haritha 000000002883 Aspen <strong>Dental</strong> Associates of NEPA, PLLC 741 Airport Rd. Hazle Township PA 18202 General Provider Luzerne<br />
Tran Joshua 000000002883 Aspen <strong>Dental</strong> Associates of NEPA, PLLC 741 Airport Rd. Hazle Township PA 18202 General Provider Luzerne<br />
Withanachchi Janatha Aspen <strong>Dental</strong> Associates of NEPA, PLLC 741 Airport Rd. Hazle Township PA 18202 Endodontist Luzerne<br />
Albertine Joseph 000000001722 Joseph Albertine DDS 239 Muir Ave. Hazleton PA 18201 General Provider Luzerne<br />
Jacques Denis 000000001807 Pittston <strong>Dental</strong> Center 34 S. Main St. Pittston PA 18640 General Provider Luzerne<br />
Polter Joel 000000001807 Pittston <strong>Dental</strong> Center 34 S. Main St. Pittston PA 18640 General Provider Luzerne<br />
LaFoca Santo 000000001724 Santo LaFoca, D.M.D. 20 N. Main St. Pittston PA 18640 General Provider Luzerne<br />
Smith Eric 000000001724 Santo LaFoca, D.M.D. 20 N. Main St. Pittston PA 18640 General Provider Luzerne<br />
Specter James Oral Surgery Associates of Wyoming Valley, <strong>Inc</strong>. 34 South Main Street Wilkes Barre PA 18701 Oral Surgeon Luzerne<br />
Zampetti Ralph Oral Surgery Associates of Wyoming Valley, <strong>Inc</strong>. 34 South Main Street Wilkes Barre PA 18701 Oral Surgeon Luzerne<br />
Babameto Blendi Aspen <strong>Dental</strong> Associates of NE PA PLLC 2168 Wilkes-Barre Township, Market Place Wilkes Barre PA 18702 Oral Surgeon Luzerne<br />
Botros Samuel 000000002240 Aspen <strong>Dental</strong> Associates of NE PA PLLC 2168 Wilkes-Barre Township, Market Place Wilkes Barre PA 18702 General Provider Luzerne<br />
Chandalada Agastayya 000000002240 Aspen <strong>Dental</strong> Associates of NE PA PLLC 2168 Wilkes-Barre Township, Market Place Wilkes Barre PA 18702 General Provider Luzerne<br />
Hamati Isam 000000002240 Aspen <strong>Dental</strong> Associates of NE PA PLLC 2168 Wilkes-Barre Township, Market Place Wilkes Barre PA 18702 General Provider Luzerne<br />
Hu Yu Hui 000000002240 Aspen <strong>Dental</strong> Associates of NE PA PLLC 2168 Wilkes-Barre Township, Market Place Wilkes Barre PA 18702 General Provider Luzerne<br />
Mercado Conchita 000000002240 Aspen <strong>Dental</strong> Associates of NE PA PLLC 2168 Wilkes-Barre Township, Market Place Wilkes Barre PA 18702 General Provider Luzerne<br />
Noel Rubins 000000002240 Aspen <strong>Dental</strong> Associates of NE PA PLLC 2168 Wilkes-Barre Township, Market Place Wilkes Barre PA 18702 General Provider Luzerne<br />
Patel Udaykumar 000000002240 Aspen <strong>Dental</strong> Associates of NE PA PLLC 2168 Wilkes-Barre Township, Market Place Wilkes Barre PA 18702 General Provider Luzerne<br />
Pham Thuy 000000002240 Aspen <strong>Dental</strong> Associates of NE PA PLLC 2168 Wilkes-Barre Township, Market Place Wilkes Barre PA 18702 General Provider Luzerne<br />
Tran Joshua 000000002240 Aspen <strong>Dental</strong> Associates of NE PA PLLC 2168 Wilkes-Barre Township, Market Place Wilkes Barre PA 18702 General Provider Luzerne<br />
Williams Christopher 000000002240 Aspen <strong>Dental</strong> Associates of NE PA PLLC 2168 Wilkes-Barre Township, Market Place Wilkes Barre PA 18702 General Provider Luzerne<br />
Withanachchi Janatha Aspen <strong>Dental</strong> Associates of NE PA PLLC 2168 Wilkes-Barre Township, Market Place Wilkes Barre PA 18702 Endodontist Luzerne<br />
Walthour William 000000000483 William Walthour, D.D.S. 213 East Market Street Wilkes Barre PA 18702 General Provider Luzerne<br />
Mastrini Louis 000000000386 Louis J. Mastrini, D.D.S. 672 North River St, Suite 209 Wilkes Barre PA 18705 General Provider Luzerne<br />
Babameto Blendi Aspen <strong>Dental</strong> Associates of NE PA PC 340 S Lycoming Mall Rd, Suite 10 Muncy PA 17756 Oral Surgeon Lycoming<br />
Botros Samuel 000000038097 Aspen <strong>Dental</strong> Associates of NE PA PC 340 S Lycoming Mall Rd, Suite 10 Muncy PA 17756 General Provider Lycoming<br />
Chandalada Agastayya 000000038097 Aspen <strong>Dental</strong> Associates of NE PA PC 340 S Lycoming Mall Rd, Suite 10 Muncy PA 17756 General Provider Lycoming<br />
Ciarallo Robert Aspen <strong>Dental</strong> Associates of NE PA PC 340 S Lycoming Mall Rd, Suite 10 Muncy PA 17756 Oral Surgeon Lycoming<br />
Harris Chad 000000038097 Aspen <strong>Dental</strong> Associates of NE PA PC 340 S Lycoming Mall Rd, Suite 10 Muncy PA 17756 General Provider Lycoming<br />
Hu Yu Hui 000000038097 Aspen <strong>Dental</strong> Associates of NE PA PC 340 S Lycoming Mall Rd, Suite 10 Muncy PA 17756 General Provider Lycoming<br />
Mercado Conchita 000000038097 Aspen <strong>Dental</strong> Associates of NE PA PC 340 S Lycoming Mall Rd, Suite 10 Muncy PA 17756 General Provider Lycoming<br />
Pham Thuy 000000038097 Aspen <strong>Dental</strong> Associates of NE PA PC 340 S Lycoming Mall Rd, Suite 10 Muncy PA 17756 General Provider Lycoming<br />
Tran Joshua 000000038097 Aspen <strong>Dental</strong> Associates of NE PA PC 340 S Lycoming Mall Rd, Suite 10 Muncy PA 17756 General Provider Lycoming<br />
Williams Christopher 000000038097 Aspen <strong>Dental</strong> Associates of NE PA PC 340 S Lycoming Mall Rd, Suite 10 Muncy PA 17756 General Provider Lycoming<br />
Withanachchi Janatha Aspen <strong>Dental</strong> Associates of NE PA PC 340 S Lycoming Mall Rd, Suite 10 Muncy PA 17756 Endodontist Lycoming<br />
Cosgrove William 000000001611 Primary Health Network/Farrell <strong>Dental</strong> Center 350 Sharon-New Castle Road Farrell PA 16121 General Provider Mercer<br />
Jeffries Christian 000000001611 Primary Health Network/Farrell <strong>Dental</strong> Center 350 Sharon-New Castle Road Farrell PA 16121 General Provider Mercer<br />
Reed John 000000001611 Primary Health Network/Farrell <strong>Dental</strong> Center 350 Sharon-New Castle Road Farrell PA 16121 General Provider Mercer<br />
Richards H. Lawrence 000000001611 Primary Health Network/Farrell <strong>Dental</strong> Center 350 Sharon-New Castle Road Farrell PA 16121 General Provider Mercer<br />
Conquest Matthew Snyder and Dugan Oral Maxillofacial Surgery 2 Greenville Orthopedic Center Greenville PA 16125 Oral Surgeon Mercer<br />
Dugan Michael Snyder and Dugan Oral Maxillofacial Surgery 2 Greenville Orthopedic Center Greenville PA 16125 Oral Surgeon Mercer<br />
* Indicates dentist that is accepting current patients only.<br />
All <strong>Select</strong> <strong>Plan</strong> <strong>Dentist</strong>s Page 26<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 <strong>Dentist</strong>. Fac ID is used to indicate which facility a member chooses.
SELECT PLAN 1 DENTIST DIRECTORY<br />
<strong>Dentist</strong>s listed are under contract as of 9/1/12<br />
Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />
Snyder Richard Snyder and Dugan Oral Maxillofacial Surgery 2 Greenville Orthopedic Center Greenville PA 16125 Oral Surgeon Mercer<br />
Sweeney Patrick Snyder and Dugan Oral Maxillofacial Surgery 2 Greenville Orthopedic Center Greenville PA 16125 Oral Surgeon Mercer<br />
Kampas Ronald Kampas Orthodontics PC 133 S Broad St Grove City PA 16127 Orthodontist Mercer<br />
Cernansky Jaime Snyder and Dugar Oral and Maxillofacial Surgery 112 S. Broad St Grove City PA 16127 Oral Surgeon Mercer<br />
Conquest Matthew Snyder and Dugar Oral and Maxillofacial Surgery 112 S. Broad St Grove City PA 16127 Oral Surgeon Mercer<br />
Dugan Michael Snyder and Dugar Oral and Maxillofacial Surgery 112 S. Broad St Grove City PA 16127 Oral Surgeon Mercer<br />
Snyder Richard Snyder and Dugar Oral and Maxillofacial Surgery 112 S. Broad St Grove City PA 16127 Oral Surgeon Mercer<br />
Sweeney Patrick Snyder and Dugar Oral and Maxillofacial Surgery 112 S. Broad St Grove City PA 16127 Oral Surgeon Mercer<br />
Aboosi Omar 000000002882 Aspen <strong>Dental</strong> Associates of Western PA PC 1049 N. Hermitage Rd. Hermitage PA 16148 General Provider Mercer<br />
Bajaj Smriti 000000002882 Aspen <strong>Dental</strong> Associates of Western PA PC 1049 N. Hermitage Rd. Hermitage PA 16148 General Provider Mercer<br />
Barber Timothy 000000002882 Aspen <strong>Dental</strong> Associates of Western PA PC 1049 N. Hermitage Rd. Hermitage PA 16148 General Provider Mercer<br />
Bonczek Brian 000000002882 Aspen <strong>Dental</strong> Associates of Western PA PC 1049 N. Hermitage Rd. Hermitage PA 16148 General Provider Mercer<br />
Budhiraj Anisha 000000002882 Aspen <strong>Dental</strong> Associates of Western PA PC 1049 N. Hermitage Rd. Hermitage PA 16148 General Provider Mercer<br />
Ciarallo Robert Aspen <strong>Dental</strong> Associates of Western PA PC 1049 N. Hermitage Rd. Hermitage PA 16148 Oral Surgeon Mercer<br />
Fnu Snigdha 000000002882 Aspen <strong>Dental</strong> Associates of Western PA PC 1049 N. Hermitage Rd. Hermitage PA 16148 General Provider Mercer<br />
Ginde Mayura 000000002882 Aspen <strong>Dental</strong> Associates of Western PA PC 1049 N. Hermitage Rd. Hermitage PA 16148 General Provider Mercer<br />
Grinberg Anna 000000002882 Aspen <strong>Dental</strong> Associates of Western PA PC 1049 N. Hermitage Rd. Hermitage PA 16148 General Provider Mercer<br />
Khalil Mirette 000000002882 Aspen <strong>Dental</strong> Associates of Western PA PC 1049 N. Hermitage Rd. Hermitage PA 16148 General Provider Mercer<br />
Liska Emily 000000002882 Aspen <strong>Dental</strong> Associates of Western PA PC 1049 N. Hermitage Rd. Hermitage PA 16148 General Provider Mercer<br />
Masown Surinder 000000002882 Aspen <strong>Dental</strong> Associates of Western PA PC 1049 N. Hermitage Rd. Hermitage PA 16148 General Provider Mercer<br />
Noel Rubins 000000002882 Aspen <strong>Dental</strong> Associates of Western PA PC 1049 N. Hermitage Rd. Hermitage PA 16148 General Provider Mercer<br />
Poleski Kenneth 000000002882 Aspen <strong>Dental</strong> Associates of Western PA PC 1049 N. Hermitage Rd. Hermitage PA 16148 General Provider Mercer<br />
Ruprecht Heather 000000002882 Aspen <strong>Dental</strong> Associates of Western PA PC 1049 N. Hermitage Rd. Hermitage PA 16148 General Provider Mercer<br />
Saba Christopher 000000002882 Aspen <strong>Dental</strong> Associates of Western PA PC 1049 N. Hermitage Rd. Hermitage PA 16148 General Provider Mercer<br />
Smith Christine 000000002882 Aspen <strong>Dental</strong> Associates of Western PA PC 1049 N. Hermitage Rd. Hermitage PA 16148 General Provider Mercer<br />
Wood Justin 000000002882 Aspen <strong>Dental</strong> Associates of Western PA PC 1049 N. Hermitage Rd. Hermitage PA 16148 General Provider Mercer<br />
Pitts LaTonya 000000002159 LaTonya E Pitts DDS 40 Chestnut Street Lewistown PA 17044 General Provider Mifflin<br />
Babameto Blendi Aspen <strong>Dental</strong> Associates of NE PA PC 1112 A North Ninth Street Stroudsburg PA 18360 Oral Surgeon Monroe<br />
Botros Samuel 000000002671 Aspen <strong>Dental</strong> Associates of NE PA PC 1112 A North Ninth Street Stroudsburg PA 18360 General Provider Monroe<br />
Chandalada Agastayya 000000002671 Aspen <strong>Dental</strong> Associates of NE PA PC 1112 A North Ninth Street Stroudsburg PA 18360 General Provider Monroe<br />
Gupta Shekhar 000000002671 Aspen <strong>Dental</strong> Associates of NE PA PC 1112 A North Ninth Street Stroudsburg PA 18360 General Provider Monroe<br />
Hu Yu Hui 000000002671 Aspen <strong>Dental</strong> Associates of NE PA PC 1112 A North Ninth Street Stroudsburg PA 18360 General Provider Monroe<br />
Mercado Conchita 000000002671 Aspen <strong>Dental</strong> Associates of NE PA PC 1112 A North Ninth Street Stroudsburg PA 18360 General Provider Monroe<br />
Noel Rubins 000000002671 Aspen <strong>Dental</strong> Associates of NE PA PC 1112 A North Ninth Street Stroudsburg PA 18360 General Provider Monroe<br />
Pham Thuy 000000002671 Aspen <strong>Dental</strong> Associates of NE PA PC 1112 A North Ninth Street Stroudsburg PA 18360 General Provider Monroe<br />
Tran Joshua 000000002671 Aspen <strong>Dental</strong> Associates of NE PA PC 1112 A North Ninth Street Stroudsburg PA 18360 General Provider Monroe<br />
Williams Christopher 000000002671 Aspen <strong>Dental</strong> Associates of NE PA PC 1112 A North Ninth Street Stroudsburg PA 18360 General Provider Monroe<br />
Withanachchi Janatha Aspen <strong>Dental</strong> Associates of NE PA PC 1112 A North Ninth Street Stroudsburg PA 18360 Endodontist Monroe<br />
Dudhat Dilip 000000002810 Abington <strong>Dental</strong> Excellence 1130 Old York Rd Abington PA 19001 General Provider Montgomery<br />
Griffith Robert Abington Oral and Maxillofacial Surgery, P.C. 1235 Old York Road, Ste 122, Levy Medical Plaza Abington PA 19001 Oral Surgeon Montgomery<br />
Ireland Charles 000000050921 Dr Charles S Ireland III PC 2400 Pershing Ave Abington PA 19001 General Provider Montgomery<br />
Cichetti Michael Cichetti & DelliGatti Orthodontics PC 7 E Skippack Pike, Suite 105 Ambler PA 19002 Orthodontist Montgomery<br />
DelliGatti Steve Cichetti & DelliGatti Orthodontics PC 7 E Skippack Pike, Suite 105 Ambler PA 19002 Orthodontist Montgomery<br />
Milewski Michael Cichetti & DelliGatti Orthodontics PC 7 E Skippack Pike, Suite 105 Ambler PA 19002 Orthodontist Montgomery<br />
Orozco Jacob Cichetti & DelliGatti Orthodontics PC 7 E Skippack Pike, Suite 105 Ambler PA 19002 Orthodontist Montgomery<br />
Bahn Paul Pediatric <strong>Dental</strong> Associates 7 E Skippack Pike Ambler PA 19002 Pedodontist Montgomery<br />
D'Agostino Alegra Pediatric <strong>Dental</strong> Associates 7 E Skippack Pike Ambler PA 19002 Pedodontist Montgomery<br />
Hamilton Sharon Pediatric <strong>Dental</strong> Associates 7 E Skippack Pike Ambler PA 19002 Pedodontist Montgomery<br />
Kay Lewis Pediatric <strong>Dental</strong> Associates 7 E Skippack Pike Ambler PA 19002 Pedodontist Montgomery<br />
Quinn Noah Pediatric <strong>Dental</strong> Associates 7 E Skippack Pike Ambler PA 19002 Pedodontist Montgomery<br />
Rosenbaum Michael Pediatric <strong>Dental</strong> Associates 7 E Skippack Pike Ambler PA 19002 Pedodontist Montgomery<br />
Thomas Kimberly Pediatric <strong>Dental</strong> Associates 7 E Skippack Pike Ambler PA 19002 Pedodontist Montgomery<br />
Panossian Antoine A+ Oral Surgery Specialty Care PC 301 City Line Ave, Suite G 5 Bala Cynwyd PA 19004 Oral Surgeon Montgomery<br />
Evans Marianna Allied Orthodontics PC 301 City Line Ave, Suite G 5 Bala Cynwyd PA 19004 Orthodontist Montgomery<br />
Adams Michael 000000002796 American <strong>Dental</strong> Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 General Provider Montgomery<br />
Bruno Frank American <strong>Dental</strong> Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 Endodontist Montgomery<br />
Chen Yang 000000002796 American <strong>Dental</strong> Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 General Provider Montgomery<br />
Cohen Hal 000000002796 American <strong>Dental</strong> Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 General Provider Montgomery<br />
Daly Gerald 000000002796 American <strong>Dental</strong> Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 General Provider Montgomery<br />
David Dan 000000002796 American <strong>Dental</strong> Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 General Provider Montgomery<br />
Edmonds R Blake 000000002796 American <strong>Dental</strong> Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 General Provider Montgomery<br />
Elkhatib Mohammad 000000002796 American <strong>Dental</strong> Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 General Provider Montgomery<br />
Fluhr Howard 000000002796 American <strong>Dental</strong> Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 General Provider Montgomery<br />
Gelbart Steven 000000002796 American <strong>Dental</strong> Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 General Provider Montgomery<br />
Kim Jae Woo 000000002796 American <strong>Dental</strong> Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 General Provider Montgomery<br />
Kim Steven American <strong>Dental</strong> Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 Periodontist Montgomery<br />
* Indicates dentist that is accepting current patients only.<br />
All <strong>Select</strong> <strong>Plan</strong> <strong>Dentist</strong>s Page 27<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 <strong>Dentist</strong>. Fac ID is used to indicate which facility a member chooses.
SELECT PLAN 1 DENTIST DIRECTORY<br />
<strong>Dentist</strong>s listed are under contract as of 9/1/12<br />
Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />
Koff Howard American <strong>Dental</strong> Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 Orthodontist Montgomery<br />
Levy Jamie American <strong>Dental</strong> Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 Oral Surgeon Montgomery<br />
Li Fuming 000000002796 American <strong>Dental</strong> Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 General Provider Montgomery<br />
Lu John American <strong>Dental</strong> Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 Periodontist Montgomery<br />
Mojahed Amir 000000002796 American <strong>Dental</strong> Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 General Provider Montgomery<br />
Mumtaz Samera 000000002796 American <strong>Dental</strong> Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 General Provider Montgomery<br />
Nguyen Diep 000000002796 American <strong>Dental</strong> Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 General Provider Montgomery<br />
Oh Jinsuk 000000002796 American <strong>Dental</strong> Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 General Provider Montgomery<br />
Pereia Christine 000000002796 American <strong>Dental</strong> Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 General Provider Montgomery<br />
Roth Michael American <strong>Dental</strong> Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 Orthodontist Montgomery<br />
Ruggieri John 000000002796 American <strong>Dental</strong> Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 General Provider Montgomery<br />
Sacks Frederick American <strong>Dental</strong> Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 Oral Surgeon Montgomery<br />
Sandhu Satinder 000000002796 American <strong>Dental</strong> Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 General Provider Montgomery<br />
Sanfacon Dennis 000000002796 American <strong>Dental</strong> Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 General Provider Montgomery<br />
Shah Nishit 000000002796 American <strong>Dental</strong> Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 General Provider Montgomery<br />
Sultana Parveen 000000002796 American <strong>Dental</strong> Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 General Provider Montgomery<br />
Thilak Preetha 000000002796 American <strong>Dental</strong> Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 General Provider Montgomery<br />
Weinstein Steven 000000002796 American <strong>Dental</strong> Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 General Provider Montgomery<br />
Yang Qing 000000002796 American <strong>Dental</strong> Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 General Provider Montgomery<br />
Yao Zheng 000000002796 American <strong>Dental</strong> Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 General Provider Montgomery<br />
Yoon Simon 000000002796 American <strong>Dental</strong> Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 General Provider Montgomery<br />
Agrawal Avanti 000000002357 American Family <strong>Dental</strong> Care PC 301 City Line, G-5 Bala Cynwyd PA 19004 General Provider Montgomery<br />
Ahmadzadeh Bijan 000000002357 American Family <strong>Dental</strong> Care PC 301 City Line, G-5 Bala Cynwyd PA 19004 General Provider Montgomery<br />
Dapkute Ingrida 000000002357 American Family <strong>Dental</strong> Care PC 301 City Line, G-5 Bala Cynwyd PA 19004 General Provider Montgomery<br />
Derosa Daniel 000000002357 American Family <strong>Dental</strong> Care PC 301 City Line, G-5 Bala Cynwyd PA 19004 General Provider Montgomery<br />
Dhyllon Amen 000000002357 American Family <strong>Dental</strong> Care PC 301 City Line, G-5 Bala Cynwyd PA 19004 General Provider Montgomery<br />
Gobron Adina 000000002357 American Family <strong>Dental</strong> Care PC 301 City Line, G-5 Bala Cynwyd PA 19004 General Provider Montgomery<br />
Kim Sunghun 000000002357 American Family <strong>Dental</strong> Care PC 301 City Line, G-5 Bala Cynwyd PA 19004 General Provider Montgomery<br />
Li Wei 000000002357 American Family <strong>Dental</strong> Care PC 301 City Line, G-5 Bala Cynwyd PA 19004 General Provider Montgomery<br />
Merin Jared 000000002357 American Family <strong>Dental</strong> Care PC 301 City Line, G-5 Bala Cynwyd PA 19004 General Provider Montgomery<br />
Miller Andrew 000000002357 American Family <strong>Dental</strong> Care PC 301 City Line, G-5 Bala Cynwyd PA 19004 General Provider Montgomery<br />
Mitelman Alexandra 000000002357 American Family <strong>Dental</strong> Care PC 301 City Line, G-5 Bala Cynwyd PA 19004 General Provider Montgomery<br />
Moriarty Sean 000000002357 American Family <strong>Dental</strong> Care PC 301 City Line, G-5 Bala Cynwyd PA 19004 General Provider Montgomery<br />
Savani Bhaskar 000000002357 American Family <strong>Dental</strong> Care PC 301 City Line, G-5 Bala Cynwyd PA 19004 General Provider Montgomery<br />
Savani Niranjan 000000002357 American Family <strong>Dental</strong> Care PC 301 City Line, G-5 Bala Cynwyd PA 19004 General Provider Montgomery<br />
Sitkovetsky Mikhail 000000002357 American Family <strong>Dental</strong> Care PC 301 City Line, G-5 Bala Cynwyd PA 19004 General Provider Montgomery<br />
Todd Meredith 000000002357 American Family <strong>Dental</strong> Care PC 301 City Line, G-5 Bala Cynwyd PA 19004 General Provider Montgomery<br />
Yanez Rafael 000000002357 American Family <strong>Dental</strong> Care PC 301 City Line, G-5 Bala Cynwyd PA 19004 General Provider Montgomery<br />
Hodges Kellyn Dr Kellyn Hodges DMD 1 Belmont Ave, Suite 414 Bala Cynwyd PA 19004 Orthodontist Montgomery<br />
Kituskie Leo Leo J. Kituskie, D.M.D., PC 794 Penlly-Blue Bell Pike Blue Bell PA 19422 Periodontist Montgomery<br />
Dudhat Dilip 000000002811 Dilip N Dudhat DMD PC 2406 North Broad Street Colmar PA 18915 General Provider Montgomery<br />
Yankosky Dennis 000000000531 Dennis E. Yankosky, D.D.S., PC 2009 Butler Pike Conshohocken PA 19428 General Provider Montgomery<br />
Bresler David David A Bresler DDS PC 1650 Linekiln Pike Dresher PA 19025 Pedodontist Montgomery<br />
Bresler Jason David A Bresler DDS PC 1650 Linekiln Pike Dresher PA 19025 Pedodontist Montgomery<br />
Bresler Joshua David A Bresler DDS PC 1650 Linekiln Pike Dresher PA 19025 Pedodontist Montgomery<br />
Mayzenberg Julia David A Bresler DDS PC 1650 Linekiln Pike Dresher PA 19025 Pedodontist Montgomery<br />
Cherian Mathew 000000051006 Advanced Family <strong>Dental</strong> Care PC 327 Township Line Rd Elkins Park PA 19027 General Provider Montgomery<br />
Adibe Elochukwu Advanced Family <strong>Dental</strong> Care PC Specialists 327 Township Line Rd Elkins Park PA 19027 Prosthodontist Montgomery<br />
Fratamico Claude 000000070928 Dr C Fratamico 7608 New Second St Elkins Park PA 19027 General Provider Montgomery<br />
Funt Mark Mark J. Funt, D.M.D., P.C. 401 Township Road, Suite C Elkins Park PA 19027 Oral Surgeon Montgomery<br />
Mehta Taral 000000070452 Taral T Mehta DMD 1811 Bethlehem Pike, Suite A102 Flourtown PA 19031 General Provider Montgomery<br />
Sayles Erik Drs Schwartz & Schelkun Associates 467 Pennsylvania Ave., Suite 106 Fort Washington PA 19034 Oral Surgeon Montgomery<br />
Schelkun Paul Drs Schwartz & Schelkun Associates 467 Pennsylvania Ave., Suite 106 Fort Washington PA 19034 Oral Surgeon Montgomery<br />
Mele Mark Mark J. Mele, D.M.D. 2826 Mt. Carmel Ave., Suite C1 Glenside PA 19038 Orthodontist Montgomery<br />
Agrawal Avanti 000000002353 A+ Family <strong>Dental</strong> Care PC 456 School Lane, Suite 104 Harleysville PA 19438 General Provider Montgomery<br />
Ahmadzadeh Bijan 000000002353 A+ Family <strong>Dental</strong> Care PC 456 School Lane, Suite 104 Harleysville PA 19438 General Provider Montgomery<br />
Dapkute Ingrida 000000002353 A+ Family <strong>Dental</strong> Care PC 456 School Lane, Suite 104 Harleysville PA 19438 General Provider Montgomery<br />
Derosa Daniel 000000002353 A+ Family <strong>Dental</strong> Care PC 456 School Lane, Suite 104 Harleysville PA 19438 General Provider Montgomery<br />
Gobron Adina 000000002353 A+ Family <strong>Dental</strong> Care PC 456 School Lane, Suite 104 Harleysville PA 19438 General Provider Montgomery<br />
Graziano Janele 000000002353 A+ Family <strong>Dental</strong> Care PC 456 School Lane, Suite 104 Harleysville PA 19438 General Provider Montgomery<br />
Lim Mee 000000002353 A+ Family <strong>Dental</strong> Care PC 456 School Lane, Suite 104 Harleysville PA 19438 General Provider Montgomery<br />
Merin Jared 000000002353 A+ Family <strong>Dental</strong> Care PC 456 School Lane, Suite 104 Harleysville PA 19438 General Provider Montgomery<br />
Mitelman Alexandra 000000002353 A+ Family <strong>Dental</strong> Care PC 456 School Lane, Suite 104 Harleysville PA 19438 General Provider Montgomery<br />
Moriarty Sean 000000002353 A+ Family <strong>Dental</strong> Care PC 456 School Lane, Suite 104 Harleysville PA 19438 General Provider Montgomery<br />
Nguyen Vu 000000002353 A+ Family <strong>Dental</strong> Care PC 456 School Lane, Suite 104 Harleysville PA 19438 General Provider Montgomery<br />
Savani Bhaskar 000000002353 A+ Family <strong>Dental</strong> Care PC 456 School Lane, Suite 104 Harleysville PA 19438 General Provider Montgomery<br />
* Indicates dentist that is accepting current patients only.<br />
All <strong>Select</strong> <strong>Plan</strong> <strong>Dentist</strong>s Page 28<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 <strong>Dentist</strong>. Fac ID is used to indicate which facility a member chooses.
SELECT PLAN 1 DENTIST DIRECTORY<br />
<strong>Dentist</strong>s listed are under contract as of 9/1/12<br />
Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />
Savani Niranjan 000000002353 A+ Family <strong>Dental</strong> Care PC 456 School Lane, Suite 104 Harleysville PA 19438 General Provider Montgomery<br />
Todd Meredith 000000002353 A+ Family <strong>Dental</strong> Care PC 456 School Lane, Suite 104 Harleysville PA 19438 General Provider Montgomery<br />
Bandelac Georges A+ Periodontic Specialty Care PC 456 School Ln, Suite 104 Harleysville PA 19438 Periodontist Montgomery<br />
Evans Marianna A+ Periodontic Specialty Care PC 456 School Ln, Suite 104 Harleysville PA 19438 Periodontist Montgomery<br />
Evans Marianna Allied Orthodontics PC 456 School Ln, Suite 101 Harleysville PA 19438 Orthodontist Montgomery<br />
Dudhat Dilip 000000051036 Advanced <strong>Dental</strong> <strong>Services</strong> PC 533 N York Rd Hatboro PA 19040 General Provider Montgomery<br />
Gevirtz David 000000000920 Horsham <strong>Dental</strong> Associates 623-A Horsham Road Horsham PA 19044 General Provider Montgomery<br />
Bresler David David A Bresler DDS PC 101 Old York Road, One Abington Plaza Suite 301 Jenkintown PA 19046 Pedodontist Montgomery<br />
Bresler Jason David A Bresler DDS PC 101 Old York Road, One Abington Plaza Suite 301 Jenkintown PA 19046 Pedodontist Montgomery<br />
Bresler Joshua David A Bresler DDS PC 101 Old York Road, One Abington Plaza Suite 301 Jenkintown PA 19046 Pedodontist Montgomery<br />
Mayzenberg Julia David A Bresler DDS PC 101 Old York Road, One Abington Plaza Suite 301 Jenkintown PA 19046 Pedodontist Montgomery<br />
Schoengold Irwin I.N. Schoengold, D.M.D. & S.J. Ziccinolfi, D.M.D. The Pavilion - Suite 323, 261 Old York Road Jenkintown PA 19046 Endodontist Montgomery<br />
Zicchnolfi Steven I.N. Schoengold, D.M.D. & S.J. Ziccinolfi, D.M.D. The Pavilion - Suite 323, 261 Old York Road Jenkintown PA 19046 Endodontist Montgomery<br />
Evian Cyril Cyril I Evian, D.M.D. 10112 Valley Forge Circle, Suite 112 King Of Prussia PA 19406 Periodontist Montgomery<br />
Wohar Robert Robert M. Wohar, D.M.D. 357 Gulph Rd, 200 King Of Prussia PA 19406 Oral Surgeon Montgomery<br />
* Javier Bonifacio 000000000391 Sumney Forge Family <strong>Dentist</strong>ry 850 S. Valley Forge Rd. Lansdale PA 19446 General Provider Montgomery<br />
Iskender Azad 000000050876 Confident Smile <strong>Dental</strong> 3 West Ridge Pike Limerick PA 19468 General Provider Montgomery<br />
Hodges Kellyn Dr Kellyn Hodges DMD 411 Doylestown Rd Montgomeryville PA 18936 Orthodontist Montgomery<br />
Habboush Sarmad 000000069566 Essex <strong>Dental</strong> 106 N Essex Ave, Suite C Narberth PA 19072 General Provider Montgomery<br />
Reddy Konreddy 000000001928 A-One <strong>Dental</strong> Care 11 West LaFayette St. Norristown PA 19401 General Provider Montgomery<br />
Rothman Marc Bernard N. Rothman, D.D.S., P.A. 1325 West Airy Street Norristown PA 19401 Oral Surgeon Montgomery<br />
Hockman Donald 000000000509 Donald F. Hockman, D.D.S. 323 W Johnson Hwy Norristown PA 19401 General Provider Montgomery<br />
Carp Brian 000000000501 Moses & Carp <strong>Dental</strong> Associates 610 W. Marshall St. Norristown PA 19401 General Provider Montgomery<br />
Yu Paul 000000000501 Moses & Carp <strong>Dental</strong> Associates 610 W. Marshall St. Norristown PA 19401 General Provider Montgomery<br />
Levito, Jr Vincent 000000061258 Vincent J Levito Jr DMD PC Family & Cosmetic Denti 1733 Markley St Norristown PA 19401 General Provider Montgomery<br />
Elbardissi Angel 000000000835 Angel W. Elbardissi, D.D.S. 210 Stump Road North Wales PA 19454 General Provider Montgomery<br />
Kim Tae-Soo 000000072104 Apple Family <strong>Dentist</strong> 275 Deklab Pike North Wales PA 19454 General Provider Montgomery<br />
Evans Marianna Allied Orthodontics PC 450 Cresson Blvd, Suite 120 Oaks PA 19456 Orthodontist Montgomery<br />
Yoon Jaewon 000000070932 American Family <strong>Dental</strong> Care 450 Cresson Blvd, Suite 210 Oaks PA 19456 General Provider Montgomery<br />
Abbott Allyson Allyson A. Abbott, D.M.D. 2050 Butler Pike, Suite 300 Plymouth Meeting PA 19462 Endodontist Montgomery<br />
Plotkin Richard Richard J. Plotkin, D.M.D. 531 W. Germantown Pike, Suite 204 Plymouth Meeting PA 19462 Oral Surgeon Montgomery<br />
Zhang Ning 000000037693 All Smile <strong>Dental</strong> Care 393 N Lewis Rd Royersford PA 19468 General Provider Montgomery<br />
Agrawal Avanti 000000050385 A+ Family <strong>Dental</strong> Care PC 744 Route 113 N Souderton PA 18964 General Provider Montgomery<br />
Ahmadzadeh Bijan 000000050385 A+ Family <strong>Dental</strong> Care PC 744 Route 113 N Souderton PA 18964 General Provider Montgomery<br />
Dapkute Ingrida 000000050385 A+ Family <strong>Dental</strong> Care PC 744 Route 113 N Souderton PA 18964 General Provider Montgomery<br />
Derosa Daniel 000000050385 A+ Family <strong>Dental</strong> Care PC 744 Route 113 N Souderton PA 18964 General Provider Montgomery<br />
Gajendran Bobby 000000050385 A+ Family <strong>Dental</strong> Care PC 744 Route 113 N Souderton PA 18964 General Provider Montgomery<br />
Gobron Adina 000000050385 A+ Family <strong>Dental</strong> Care PC 744 Route 113 N Souderton PA 18964 General Provider Montgomery<br />
Lee Young 000000050385 A+ Family <strong>Dental</strong> Care PC 744 Route 113 N Souderton PA 18964 General Provider Montgomery<br />
Merin Jared 000000050385 A+ Family <strong>Dental</strong> Care PC 744 Route 113 N Souderton PA 18964 General Provider Montgomery<br />
Mitelman Alexandra 000000050385 A+ Family <strong>Dental</strong> Care PC 744 Route 113 N Souderton PA 18964 General Provider Montgomery<br />
Moriarty Sean 000000050385 A+ Family <strong>Dental</strong> Care PC 744 Route 113 N Souderton PA 18964 General Provider Montgomery<br />
Savani Bhaskar 000000050385 A+ Family <strong>Dental</strong> Care PC 744 Route 113 N Souderton PA 18964 General Provider Montgomery<br />
Savani Niranjan 000000050385 A+ Family <strong>Dental</strong> Care PC 744 Route 113 N Souderton PA 18964 General Provider Montgomery<br />
Todd Meredith 000000050385 A+ Family <strong>Dental</strong> Care PC 744 Route 113 N Souderton PA 18964 General Provider Montgomery<br />
Bhatnagar Payal 000000002580 Aspen <strong>Dental</strong> 841 South 25th Street Easton PA 18045 General Provider Northampton<br />
Chadha Chandan 000000002580 Aspen <strong>Dental</strong> 841 South 25th Street Easton PA 18045 General Provider Northampton<br />
Chaudhry Ahmad 000000002580 Aspen <strong>Dental</strong> 841 South 25th Street Easton PA 18045 General Provider Northampton<br />
Kim Peter 000000002580 Aspen <strong>Dental</strong> 841 South 25th Street Easton PA 18045 General Provider Northampton<br />
Malhotra Swati 000000002580 Aspen <strong>Dental</strong> 841 South 25th Street Easton PA 18045 General Provider Northampton<br />
Obaid Michel 000000002580 Aspen <strong>Dental</strong> 841 South 25th Street Easton PA 18045 General Provider Northampton<br />
Rajput Bhumika 000000002580 Aspen <strong>Dental</strong> 841 South 25th Street Easton PA 18045 General Provider Northampton<br />
Sambaraju Haritha 000000002580 Aspen <strong>Dental</strong> 841 South 25th Street Easton PA 18045 General Provider Northampton<br />
Withanachchi Janatha Aspen <strong>Dental</strong> 841 South 25th Street Easton PA 18045 Endodontist Northampton<br />
Yi Tyler 000000002580 Aspen <strong>Dental</strong> 841 South 25th Street Easton PA 18045 General Provider Northampton<br />
Chacker Laurence Associated <strong>Dental</strong> Specialties 1601Walnut Street, Suite 201 Philadelphia PA 19102 Periodontist Philadelphia<br />
Weinberg Martin 000000000905 Drs. Weinberg & Goldberg, D.D.S. 1528 Walnut Street, Suite 1725 Philadelphia PA 19102 General Provider Philadelphia<br />
Braid Stanton Stanton Braid, D.M.D. 1521 Locust Street, Suite 100 Philadelphia PA 19102 Oral Surgeon Philadelphia<br />
Tinkelman Carl Carl L. Tinkelman, D.M.D., PC 255 South 17th Street, Ste.1806 Philadelphia PA 19103 Endodontist Philadelphia<br />
Aranbayev Yefim 000000069968 Dentex <strong>Dental</strong> Group Ltd 1625 Chestnut St, Suite 228 Philadelphia PA 19103 General Provider Philadelphia<br />
Choi Bokyu 000000069968 Dentex <strong>Dental</strong> Group Ltd 1625 Chestnut St, Suite 228 Philadelphia PA 19103 General Provider Philadelphia<br />
Cohen Ronald 000000069968 Dentex <strong>Dental</strong> Group Ltd 1625 Chestnut St, Suite 228 Philadelphia PA 19103 General Provider Philadelphia<br />
Genkin Alexander 000000069968 Dentex <strong>Dental</strong> Group Ltd 1625 Chestnut St, Suite 228 Philadelphia PA 19103 General Provider Philadelphia<br />
Go Satoshi 000000069968 Dentex <strong>Dental</strong> Group Ltd 1625 Chestnut St, Suite 228 Philadelphia PA 19103 General Provider Philadelphia<br />
Joo Esther 000000069968 Dentex <strong>Dental</strong> Group Ltd 1625 Chestnut St, Suite 228 Philadelphia PA 19103 General Provider Philadelphia<br />
Kim Nari 000000069968 Dentex <strong>Dental</strong> Group Ltd 1625 Chestnut St, Suite 228 Philadelphia PA 19103 General Provider Philadelphia<br />
* Indicates dentist that is accepting current patients only.<br />
All <strong>Select</strong> <strong>Plan</strong> <strong>Dentist</strong>s Page 29<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 <strong>Dentist</strong>. Fac ID is used to indicate which facility a member chooses.
SELECT PLAN 1 DENTIST DIRECTORY<br />
<strong>Dentist</strong>s listed are under contract as of 9/1/12<br />
Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />
Levites Margarita 000000069968 Dentex <strong>Dental</strong> Group Ltd 1625 Chestnut St, Suite 228 Philadelphia PA 19103 General Provider Philadelphia<br />
Moon Daeuk 000000069968 Dentex <strong>Dental</strong> Group Ltd 1625 Chestnut St, Suite 228 Philadelphia PA 19103 General Provider Philadelphia<br />
Plotnik Igor 000000069968 Dentex <strong>Dental</strong> Group Ltd 1625 Chestnut St, Suite 228 Philadelphia PA 19103 General Provider Philadelphia<br />
Sedaghat Shabnam 000000069968 Dentex <strong>Dental</strong> Group Ltd 1625 Chestnut St, Suite 228 Philadelphia PA 19103 General Provider Philadelphia<br />
Zhang Chengfeng 000000069968 Dentex <strong>Dental</strong> Group Ltd 1625 Chestnut St, Suite 228 Philadelphia PA 19103 General Provider Philadelphia<br />
Zilberman Alexander 000000069968 Dentex <strong>Dental</strong> Group Ltd 1625 Chestnut St, Suite 228 Philadelphia PA 19103 General Provider Philadelphia<br />
Yurovsky Renee 000000038098 Renee Yurovsky DDS PC 1831 Chestnut St, Suite 100 Philadelphia PA 19103 General Provider Philadelphia<br />
Wolgin Joshua Wolgin Endodontic Group 255 S 17th St, Suite 1806 Philadelphia PA 19103 Endodontist Philadelphia<br />
Young Eugene 000000069549 Dr Young & Associates LLC 4310 Walnut St Philadelphia PA 19104 General Provider Philadelphia<br />
Yanez Rafael 000000068457 All About Your Smile PC 200 Walnut St Philadelphia PA 19106 General Provider Philadelphia<br />
Adams Michael 000000002792 American <strong>Dental</strong> Care, PC 722 Market Street Philadelphia PA 19106 General Provider Philadelphia<br />
Blumenthal Mitchel 000000002792 American <strong>Dental</strong> Care, PC 722 Market Street Philadelphia PA 19106 General Provider Philadelphia<br />
Bruno Frank American <strong>Dental</strong> Care, PC 722 Market Street Philadelphia PA 19106 Endodontist Philadelphia<br />
Chen Yang 000000002792 American <strong>Dental</strong> Care, PC 722 Market Street Philadelphia PA 19106 General Provider Philadelphia<br />
Cohen Hal 000000002792 American <strong>Dental</strong> Care, PC 722 Market Street Philadelphia PA 19106 General Provider Philadelphia<br />
Daly Gerald 000000002792 American <strong>Dental</strong> Care, PC 722 Market Street Philadelphia PA 19106 General Provider Philadelphia<br />
David Dan 000000002792 American <strong>Dental</strong> Care, PC 722 Market Street Philadelphia PA 19106 General Provider Philadelphia<br />
Edmonds R Blake 000000002792 American <strong>Dental</strong> Care, PC 722 Market Street Philadelphia PA 19106 General Provider Philadelphia<br />
Elkhatib Mohammad 000000002792 American <strong>Dental</strong> Care, PC 722 Market Street Philadelphia PA 19106 General Provider Philadelphia<br />
Fluhr Howard 000000002792 American <strong>Dental</strong> Care, PC 722 Market Street Philadelphia PA 19106 General Provider Philadelphia<br />
Gelbart Steven 000000002792 American <strong>Dental</strong> Care, PC 722 Market Street Philadelphia PA 19106 General Provider Philadelphia<br />
Kim Jae Woo 000000002792 American <strong>Dental</strong> Care, PC 722 Market Street Philadelphia PA 19106 General Provider Philadelphia<br />
Kim Steven American <strong>Dental</strong> Care, PC 722 Market Street Philadelphia PA 19106 Periodontist Philadelphia<br />
Koff Howard American <strong>Dental</strong> Care, PC 722 Market Street Philadelphia PA 19106 Orthodontist Philadelphia<br />
Levy Jamie American <strong>Dental</strong> Care, PC 722 Market Street Philadelphia PA 19106 Oral Surgeon Philadelphia<br />
Li Fuming 000000002792 American <strong>Dental</strong> Care, PC 722 Market Street Philadelphia PA 19106 General Provider Philadelphia<br />
Lu John American <strong>Dental</strong> Care, PC 722 Market Street Philadelphia PA 19106 Periodontist Philadelphia<br />
Mojahed Amir 000000002792 American <strong>Dental</strong> Care, PC 722 Market Street Philadelphia PA 19106 General Provider Philadelphia<br />
Mumtaz Samera 000000002792 American <strong>Dental</strong> Care, PC 722 Market Street Philadelphia PA 19106 General Provider Philadelphia<br />
Nguyen Diep 000000002792 American <strong>Dental</strong> Care, PC 722 Market Street Philadelphia PA 19106 General Provider Philadelphia<br />
Oh Jinsuk 000000002792 American <strong>Dental</strong> Care, PC 722 Market Street Philadelphia PA 19106 General Provider Philadelphia<br />
Pereia Christine 000000002792 American <strong>Dental</strong> Care, PC 722 Market Street Philadelphia PA 19106 General Provider Philadelphia<br />
Roth Michael American <strong>Dental</strong> Care, PC 722 Market Street Philadelphia PA 19106 Orthodontist Philadelphia<br />
Ruggieri John 000000002792 American <strong>Dental</strong> Care, PC 722 Market Street Philadelphia PA 19106 General Provider Philadelphia<br />
Sacks Frederick American <strong>Dental</strong> Care, PC 722 Market Street Philadelphia PA 19106 Oral Surgeon Philadelphia<br />
Sandhu Satinder 000000002792 American <strong>Dental</strong> Care, PC 722 Market Street Philadelphia PA 19106 General Provider Philadelphia<br />
Sanfacon Dennis 000000002792 American <strong>Dental</strong> Care, PC 722 Market Street Philadelphia PA 19106 General Provider Philadelphia<br />
Shah Nishit 000000002792 American <strong>Dental</strong> Care, PC 722 Market Street Philadelphia PA 19106 General Provider Philadelphia<br />
Shamseddin Seyed American <strong>Dental</strong> Care, PC 722 Market Street Philadelphia PA 19106 Periodontist Philadelphia<br />
Sultana Parveen 000000002792 American <strong>Dental</strong> Care, PC 722 Market Street Philadelphia PA 19106 General Provider Philadelphia<br />
Thilak Preetha 000000002792 American <strong>Dental</strong> Care, PC 722 Market Street Philadelphia PA 19106 General Provider Philadelphia<br />
Weinstein Steven 000000002792 American <strong>Dental</strong> Care, PC 722 Market Street Philadelphia PA 19106 General Provider Philadelphia<br />
Yang Qing 000000002792 American <strong>Dental</strong> Care, PC 722 Market Street Philadelphia PA 19106 General Provider Philadelphia<br />
Yao Zheng 000000002792 American <strong>Dental</strong> Care, PC 722 Market Street Philadelphia PA 19106 General Provider Philadelphia<br />
Yoon Simon 000000002792 American <strong>Dental</strong> Care, PC 722 Market Street Philadelphia PA 19106 General Provider Philadelphia<br />
Ghani Mohammad 000000002261 Advance <strong>Dental</strong> Care Consultants 1225 Vine Street, Suite 401 Philadelphia PA 19107 General Provider Philadelphia<br />
* Young Eugene 000000001194 Dr Young & Associates LLC 924 Arch St. Philadelphia PA 19107 General Provider Philadelphia<br />
Paul Prolay 000000050725 Gallery Mall <strong>Dental</strong> PC 901 Market St, Space 3220 Philadelphia PA 19107 General Provider Philadelphia<br />
Shah Shreyas 000000050725 Gallery Mall <strong>Dental</strong> PC 901 Market St, Space 3220 Philadelphia PA 19107 General Provider Philadelphia<br />
Cho Sung Jefferson Oral & Maxillofacial Surgery 909 Walnut St, Suite 300 COB Philadelphia PA 19107 Oral Surgeon Philadelphia<br />
Diecidue Robert Jefferson Oral & Maxillofacial Surgery 909 Walnut St, Suite 300 COB Philadelphia PA 19107 Oral Surgeon Philadelphia<br />
Taub Daniel Jefferson Oral & Maxillofacial Surgery 909 Walnut St, Suite 300 COB Philadelphia PA 19107 Oral Surgeon Philadelphia<br />
Bahram Ramin Oral Surgery Consultants of PA 1601 Walnut Street, Suite 1207 Philadelphia PA 19107 Oral Surgeon Philadelphia<br />
Bowser Daniel Oral Surgery Consultants of PA 1601 Walnut Street, Suite 1207 Philadelphia PA 19107 Oral Surgeon Philadelphia<br />
Richman Brad Oral Surgery Consultants of PA 1601 Walnut Street, Suite 1207 Philadelphia PA 19107 Oral Surgeon Philadelphia<br />
Donskoy Jennifer 000000051123 DentaLux LLC 1308 Cottman Ave Philadelphia PA 19111 General Provider Philadelphia<br />
Goldberg Robert 000000051123 DentaLux LLC 1308 Cottman Ave Philadelphia PA 19111 General Provider Philadelphia<br />
Aranbayev Yefim 000000069969 Dentex <strong>Dental</strong> Group Ltd 6227 Rising Sun Ave Philadelphia PA 19111 General Provider Philadelphia<br />
Choi Bokyu 000000069969 Dentex <strong>Dental</strong> Group Ltd 6227 Rising Sun Ave Philadelphia PA 19111 General Provider Philadelphia<br />
Cohen Ronald 000000069969 Dentex <strong>Dental</strong> Group Ltd 6227 Rising Sun Ave Philadelphia PA 19111 General Provider Philadelphia<br />
Genkin Alexander 000000069969 Dentex <strong>Dental</strong> Group Ltd 6227 Rising Sun Ave Philadelphia PA 19111 General Provider Philadelphia<br />
Go Satoshi 000000069969 Dentex <strong>Dental</strong> Group Ltd 6227 Rising Sun Ave Philadelphia PA 19111 General Provider Philadelphia<br />
Joo Esther 000000069969 Dentex <strong>Dental</strong> Group Ltd 6227 Rising Sun Ave Philadelphia PA 19111 General Provider Philadelphia<br />
Kim Nari 000000069969 Dentex <strong>Dental</strong> Group Ltd 6227 Rising Sun Ave Philadelphia PA 19111 General Provider Philadelphia<br />
Levites Margarita 000000069969 Dentex <strong>Dental</strong> Group Ltd 6227 Rising Sun Ave Philadelphia PA 19111 General Provider Philadelphia<br />
Moon Daeuk 000000069969 Dentex <strong>Dental</strong> Group Ltd 6227 Rising Sun Ave Philadelphia PA 19111 General Provider Philadelphia<br />
* Indicates dentist that is accepting current patients only.<br />
All <strong>Select</strong> <strong>Plan</strong> <strong>Dentist</strong>s Page 30<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 <strong>Dentist</strong>. Fac ID is used to indicate which facility a member chooses.
SELECT PLAN 1 DENTIST DIRECTORY<br />
<strong>Dentist</strong>s listed are under contract as of 9/1/12<br />
Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />
Plotnik Igor 000000069969 Dentex <strong>Dental</strong> Group Ltd 6227 Rising Sun Ave Philadelphia PA 19111 General Provider Philadelphia<br />
Sedaghat Shabnam 000000069969 Dentex <strong>Dental</strong> Group Ltd 6227 Rising Sun Ave Philadelphia PA 19111 General Provider Philadelphia<br />
Zhang Chengfeng 000000069969 Dentex <strong>Dental</strong> Group Ltd 6227 Rising Sun Ave Philadelphia PA 19111 General Provider Philadelphia<br />
Zilberman Alexander 000000069969 Dentex <strong>Dental</strong> Group Ltd 6227 Rising Sun Ave Philadelphia PA 19111 General Provider Philadelphia<br />
Chadhalavada Kavitha 000000068449 Eastern <strong>Dental</strong> Associates of Cottman Avenue 1936 Cottman Ave Philadelphia PA 19111 General Provider Philadelphia<br />
Vora Vasant 000000000838 Vasant K. Vora, D.D.S. 907 Tyson Ave, PO Box 11436 Philadelphia PA 19111 General Provider Philadelphia<br />
Adams Michael 000000002797 American <strong>Dental</strong> Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General Provider Philadelphia<br />
Blumenthal Mitchel 000000002797 American <strong>Dental</strong> Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General Provider Philadelphia<br />
Bruno Frank American <strong>Dental</strong> Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 Endodontist Philadelphia<br />
Chen Yang 000000002797 American <strong>Dental</strong> Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General Provider Philadelphia<br />
Cohen Hal 000000002797 American <strong>Dental</strong> Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General Provider Philadelphia<br />
Daly Gerald 000000002797 American <strong>Dental</strong> Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General Provider Philadelphia<br />
David Dan 000000002797 American <strong>Dental</strong> Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General Provider Philadelphia<br />
Edmonds R Blake 000000002797 American <strong>Dental</strong> Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General Provider Philadelphia<br />
Elkhatib Mohammad 000000002797 American <strong>Dental</strong> Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General Provider Philadelphia<br />
Fluhr Howard 000000002797 American <strong>Dental</strong> Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General Provider Philadelphia<br />
Gelbart Steven 000000002797 American <strong>Dental</strong> Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General Provider Philadelphia<br />
Kim Jae Woo 000000002797 American <strong>Dental</strong> Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General Provider Philadelphia<br />
Kim Steven American <strong>Dental</strong> Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 Periodontist Philadelphia<br />
Koff Howard American <strong>Dental</strong> Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 Orthodontist Philadelphia<br />
Levy Jamie American <strong>Dental</strong> Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 Oral Surgeon Philadelphia<br />
Li Fuming 000000002797 American <strong>Dental</strong> Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General Provider Philadelphia<br />
Lu John American <strong>Dental</strong> Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 Periodontist Philadelphia<br />
Mojahed Amir 000000002797 American <strong>Dental</strong> Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General Provider Philadelphia<br />
Mumtaz Samera 000000002797 American <strong>Dental</strong> Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General Provider Philadelphia<br />
Nguyen Diep 000000002797 American <strong>Dental</strong> Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General Provider Philadelphia<br />
Oh Jinsuk 000000002797 American <strong>Dental</strong> Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General Provider Philadelphia<br />
Pereia Christine 000000002797 American <strong>Dental</strong> Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General Provider Philadelphia<br />
Roth Michael American <strong>Dental</strong> Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 Orthodontist Philadelphia<br />
Ruggieri John 000000002797 American <strong>Dental</strong> Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General Provider Philadelphia<br />
Sacks Frederick American <strong>Dental</strong> Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 Oral Surgeon Philadelphia<br />
Sandhu Satinder 000000002797 American <strong>Dental</strong> Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General Provider Philadelphia<br />
Sanfacon Dennis 000000002797 American <strong>Dental</strong> Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General Provider Philadelphia<br />
Shah Nishit 000000002797 American <strong>Dental</strong> Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General Provider Philadelphia<br />
Sultana Parveen 000000002797 American <strong>Dental</strong> Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General Provider Philadelphia<br />
Thilak Preetha 000000002797 American <strong>Dental</strong> Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General Provider Philadelphia<br />
Weinstein Steven 000000002797 American <strong>Dental</strong> Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General Provider Philadelphia<br />
Yang Qing 000000002797 American <strong>Dental</strong> Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General Provider Philadelphia<br />
Yao Zheng 000000002797 American <strong>Dental</strong> Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General Provider Philadelphia<br />
Yoon Simon 000000002797 American <strong>Dental</strong> Care, PC 9229 Roosevelt Blvd Philadelphia PA 19114 General Provider Philadelphia<br />
Bresler David David A Bresler DDS PC 240 Geiger Rd. Philadelphia PA 19115 Pedodontist Philadelphia<br />
Bresler Jason David A Bresler DDS PC 240 Geiger Rd. Philadelphia PA 19115 Pedodontist Philadelphia<br />
Bresler Joshua David A Bresler DDS PC 240 Geiger Rd. Philadelphia PA 19115 Pedodontist Philadelphia<br />
Mayzenberg Julia David A Bresler DDS PC 240 Geiger Rd. Philadelphia PA 19115 Pedodontist Philadelphia<br />
Bresler David Doc Breslers Cavity Busters 1916 Welsh Rd Philadelphia PA 19115 Pedodontist Philadelphia<br />
Bresler Jason Doc Breslers Cavity Busters 1916 Welsh Rd Philadelphia PA 19115 Pedodontist Philadelphia<br />
Bresler Joshua Doc Breslers Cavity Busters 1916 Welsh Rd Philadelphia PA 19115 Pedodontist Philadelphia<br />
Jacobson Irving Doc Breslers Cavity Busters 1916 Welsh Rd Philadelphia PA 19115 Pedodontist Philadelphia<br />
Mayzenberg Julia Doc Breslers Cavity Busters 1916 Welsh Rd Philadelphia PA 19115 Pedodontist Philadelphia<br />
Uppal Gagan 000000050646 AC <strong>Dental</strong> of NE Philly 10000 Roosevelt Blvd Philadelphia PA 19116 General Provider Philadelphia<br />
Burdo Gregory Da Vinci <strong>Dental</strong> Specialists 10108 Bustleton Ave Philadelphia PA 19116 Periodontist Philadelphia<br />
Aranbayev Yefim 000000069572 Dentex <strong>Dental</strong> Group Ltd 10108 Bustleton Ave Philadelphia PA 19116 General Provider Philadelphia<br />
Choi Bokyu 000000069572 Dentex <strong>Dental</strong> Group Ltd 10108 Bustleton Ave Philadelphia PA 19116 General Provider Philadelphia<br />
Cohen Ronald 000000069572 Dentex <strong>Dental</strong> Group Ltd 10108 Bustleton Ave Philadelphia PA 19116 General Provider Philadelphia<br />
Genkin Alexander 000000069572 Dentex <strong>Dental</strong> Group Ltd 10108 Bustleton Ave Philadelphia PA 19116 General Provider Philadelphia<br />
Go Satoshi 000000069572 Dentex <strong>Dental</strong> Group Ltd 10108 Bustleton Ave Philadelphia PA 19116 General Provider Philadelphia<br />
Joo Esther 000000069572 Dentex <strong>Dental</strong> Group Ltd 10108 Bustleton Ave Philadelphia PA 19116 General Provider Philadelphia<br />
Kim Nari 000000069572 Dentex <strong>Dental</strong> Group Ltd 10108 Bustleton Ave Philadelphia PA 19116 General Provider Philadelphia<br />
Levites Margarita 000000069572 Dentex <strong>Dental</strong> Group Ltd 10108 Bustleton Ave Philadelphia PA 19116 General Provider Philadelphia<br />
Moon Daeuk 000000069572 Dentex <strong>Dental</strong> Group Ltd 10108 Bustleton Ave Philadelphia PA 19116 General Provider Philadelphia<br />
Plotnik Igor 000000069572 Dentex <strong>Dental</strong> Group Ltd 10108 Bustleton Ave Philadelphia PA 19116 General Provider Philadelphia<br />
Sedaghat Shabnam 000000069572 Dentex <strong>Dental</strong> Group Ltd 10108 Bustleton Ave Philadelphia PA 19116 General Provider Philadelphia<br />
Zhang Chengfeng 000000069572 Dentex <strong>Dental</strong> Group Ltd 10108 Bustleton Ave Philadelphia PA 19116 General Provider Philadelphia<br />
Zilberman Alexander 000000069572 Dentex <strong>Dental</strong> Group Ltd 10108 Bustleton Ave Philadelphia PA 19116 General Provider Philadelphia<br />
Abraham Kurian 000000002790 Kurian M. Abraham, D.D.S. 11001 Bustleton Ave. Philadelphia PA 19116 General Provider Philadelphia<br />
Amayev Oleg 000000068524 Northeast <strong>Dental</strong> Center 10847 Bustleton Ave Philadelphia PA 19116 General Provider Philadelphia<br />
* Indicates dentist that is accepting current patients only.<br />
All <strong>Select</strong> <strong>Plan</strong> <strong>Dentist</strong>s Page 31<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 <strong>Dentist</strong>. Fac ID is used to indicate which facility a member chooses.
SELECT PLAN 1 DENTIST DIRECTORY<br />
<strong>Dentist</strong>s listed are under contract as of 9/1/12<br />
Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />
Patoliya Keyur 000000080785 Advanced <strong>Dental</strong> Designs, PC 6529 Gernamtown Ave Philadelphia PA 19119 General Provider Philadelphia<br />
Panossian Antoine A+ Oral Surgery Specialty Care PC 600 W Olney Ave Philadelphia PA 19120 Oral Surgeon Philadelphia<br />
Abdelkader Ahmed 000000069557 Abdelkader Family <strong>Dentist</strong>ry 358 E Wyoming Ave Philadelphia PA 19120 General Provider Philadelphia<br />
Agrawal Avanti 000000002355 Advanced Family <strong>Dentist</strong>ry PC 600 West Olney Avenue Philadelphia PA 19120 General Provider Philadelphia<br />
Ahmadzadeh Bijan 000000002355 Advanced Family <strong>Dentist</strong>ry PC 600 West Olney Avenue Philadelphia PA 19120 General Provider Philadelphia<br />
Dapkute Ingrida 000000002355 Advanced Family <strong>Dentist</strong>ry PC 600 West Olney Avenue Philadelphia PA 19120 General Provider Philadelphia<br />
Derosa Daniel 000000002355 Advanced Family <strong>Dentist</strong>ry PC 600 West Olney Avenue Philadelphia PA 19120 General Provider Philadelphia<br />
Dhyllon Amen 000000002355 Advanced Family <strong>Dentist</strong>ry PC 600 West Olney Avenue Philadelphia PA 19120 General Provider Philadelphia<br />
Gherca Mirabela 000000002355 Advanced Family <strong>Dentist</strong>ry PC 600 West Olney Avenue Philadelphia PA 19120 General Provider Philadelphia<br />
Gobron Adina 000000002355 Advanced Family <strong>Dentist</strong>ry PC 600 West Olney Avenue Philadelphia PA 19120 General Provider Philadelphia<br />
Hwang Sookie 000000002355 Advanced Family <strong>Dentist</strong>ry PC 600 West Olney Avenue Philadelphia PA 19120 General Provider Philadelphia<br />
Iheoma Esochi 000000002355 Advanced Family <strong>Dentist</strong>ry PC 600 West Olney Avenue Philadelphia PA 19120 General Provider Philadelphia<br />
Kim Angie 000000002355 Advanced Family <strong>Dentist</strong>ry PC 600 West Olney Avenue Philadelphia PA 19120 General Provider Philadelphia<br />
Merin Jared 000000002355 Advanced Family <strong>Dentist</strong>ry PC 600 West Olney Avenue Philadelphia PA 19120 General Provider Philadelphia<br />
Mitelman Alexandra 000000002355 Advanced Family <strong>Dentist</strong>ry PC 600 West Olney Avenue Philadelphia PA 19120 General Provider Philadelphia<br />
Moriarty Sean 000000002355 Advanced Family <strong>Dentist</strong>ry PC 600 West Olney Avenue Philadelphia PA 19120 General Provider Philadelphia<br />
Savani Bhaskar 000000002355 Advanced Family <strong>Dentist</strong>ry PC 600 West Olney Avenue Philadelphia PA 19120 General Provider Philadelphia<br />
Savani Niranjan 000000002355 Advanced Family <strong>Dentist</strong>ry PC 600 West Olney Avenue Philadelphia PA 19120 General Provider Philadelphia<br />
Todd Meredith 000000002355 Advanced Family <strong>Dentist</strong>ry PC 600 West Olney Avenue Philadelphia PA 19120 General Provider Philadelphia<br />
* Kim Kook 000000068535 Kook Kan Kim DMD 5438 N Lawrence St Philadelphia PA 19120 General Provider Philadelphia<br />
Ravatez Lisa 000000001178 Lisa Ann Ravetz, D.M.D. 199 W Champlost Ave. Philadelphia PA 19120 General Provider Philadelphia<br />
Saraf Neha 000000061299 Smiles for Miles <strong>Dental</strong> Group 551 Adams Ave Philadelphia PA 19120 General Provider Philadelphia<br />
Berrios Karen 000000002779 Vaux Family Health Center 2300 W Master St Philadelphia PA 19121 General Provider Philadelphia<br />
Crawford Charles 000000002779 Vaux Family Health Center 2300 W Master St Philadelphia PA 19121 General Provider Philadelphia<br />
Frare Robert 000000002779 Vaux Family Health Center 2300 W Master St Philadelphia PA 19121 General Provider Philadelphia<br />
Hussain Fahmida 000000002779 Vaux Family Health Center 2300 W Master St Philadelphia PA 19121 General Provider Philadelphia<br />
Dheer Nisha 000000037861 GPHA Frankford Avenue <strong>Dental</strong> Center 4510 Frankford Ave Philadelphia PA 19124 General Provider Philadelphia<br />
Drysdale Robert 000000037861 GPHA Frankford Avenue <strong>Dental</strong> Center 4510 Frankford Ave Philadelphia PA 19124 General Provider Philadelphia<br />
Elsey Riina 000000037861 GPHA Frankford Avenue <strong>Dental</strong> Center 4510 Frankford Ave Philadelphia PA 19124 General Provider Philadelphia<br />
Fadl Reem 000000037861 GPHA Frankford Avenue <strong>Dental</strong> Center 4510 Frankford Ave Philadelphia PA 19124 General Provider Philadelphia<br />
Hao Shenquan 000000037861 GPHA Frankford Avenue <strong>Dental</strong> Center 4510 Frankford Ave Philadelphia PA 19124 General Provider Philadelphia<br />
Jubiril-Taylor Linda 000000037861 GPHA Frankford Avenue <strong>Dental</strong> Center 4510 Frankford Ave Philadelphia PA 19124 General Provider Philadelphia<br />
Lloyd Arnelle 000000037861 GPHA Frankford Avenue <strong>Dental</strong> Center 4510 Frankford Ave Philadelphia PA 19124 General Provider Philadelphia<br />
Owens Jessica 000000037861 GPHA Frankford Avenue <strong>Dental</strong> Center 4510 Frankford Ave Philadelphia PA 19124 General Provider Philadelphia<br />
Soapes Kenneth 000000068471 Kenneth J Soapes DMD 1526 Pratt St Philadelphia PA 19124 General Provider Philadelphia<br />
Bahn Paul Pediatric <strong>Dental</strong> Associates 100 E Lehigh Ave Philadelphia PA 19125 Pedodontist Philadelphia<br />
D'Agostino Alegra Pediatric <strong>Dental</strong> Associates 100 E Lehigh Ave Philadelphia PA 19125 Pedodontist Philadelphia<br />
Hamilton Sharon Pediatric <strong>Dental</strong> Associates 100 E Lehigh Ave Philadelphia PA 19125 Pedodontist Philadelphia<br />
Kay Lewis Pediatric <strong>Dental</strong> Associates 100 E Lehigh Ave Philadelphia PA 19125 Pedodontist Philadelphia<br />
Quinn Noah Pediatric <strong>Dental</strong> Associates 100 E Lehigh Ave Philadelphia PA 19125 Pedodontist Philadelphia<br />
Rosenbaum Michael Pediatric <strong>Dental</strong> Associates 100 E Lehigh Ave Philadelphia PA 19125 Pedodontist Philadelphia<br />
Thomas Kimberly Pediatric <strong>Dental</strong> Associates 100 E Lehigh Ave Philadelphia PA 19125 Pedodontist Philadelphia<br />
Adams Michael 000000002798 American <strong>Dental</strong> Care, PC 6162 Ridge Ave Philadelphia PA 19128 General Provider Philadelphia<br />
Bruno Frank American <strong>Dental</strong> Care, PC 6162 Ridge Ave Philadelphia PA 19128 Endodontist Philadelphia<br />
Chen Yang 000000002798 American <strong>Dental</strong> Care, PC 6162 Ridge Ave Philadelphia PA 19128 General Provider Philadelphia<br />
Cohen Hal 000000002798 American <strong>Dental</strong> Care, PC 6162 Ridge Ave Philadelphia PA 19128 General Provider Philadelphia<br />
Daly Gerald 000000002798 American <strong>Dental</strong> Care, PC 6162 Ridge Ave Philadelphia PA 19128 General Provider Philadelphia<br />
David Dan 000000002798 American <strong>Dental</strong> Care, PC 6162 Ridge Ave Philadelphia PA 19128 General Provider Philadelphia<br />
Edmonds R Blake 000000002798 American <strong>Dental</strong> Care, PC 6162 Ridge Ave Philadelphia PA 19128 General Provider Philadelphia<br />
Elkhatib Mohammad 000000002798 American <strong>Dental</strong> Care, PC 6162 Ridge Ave Philadelphia PA 19128 General Provider Philadelphia<br />
Fluhr Howard 000000002798 American <strong>Dental</strong> Care, PC 6162 Ridge Ave Philadelphia PA 19128 General Provider Philadelphia<br />
Gelbart Steven 000000002798 American <strong>Dental</strong> Care, PC 6162 Ridge Ave Philadelphia PA 19128 General Provider Philadelphia<br />
Kim Jae Woo 000000002798 American <strong>Dental</strong> Care, PC 6162 Ridge Ave Philadelphia PA 19128 General Provider Philadelphia<br />
Kim Steven American <strong>Dental</strong> Care, PC 6162 Ridge Ave Philadelphia PA 19128 Periodontist Philadelphia<br />
Koff Howard American <strong>Dental</strong> Care, PC 6162 Ridge Ave Philadelphia PA 19128 Orthodontist Philadelphia<br />
Levy Jamie American <strong>Dental</strong> Care, PC 6162 Ridge Ave Philadelphia PA 19128 Oral Surgeon Philadelphia<br />
Li Fuming 000000002798 American <strong>Dental</strong> Care, PC 6162 Ridge Ave Philadelphia PA 19128 General Provider Philadelphia<br />
Lu John American <strong>Dental</strong> Care, PC 6162 Ridge Ave Philadelphia PA 19128 Periodontist Philadelphia<br />
Mojahed Amir 000000002798 American <strong>Dental</strong> Care, PC 6162 Ridge Ave Philadelphia PA 19128 General Provider Philadelphia<br />
Mumtaz Samera 000000002798 American <strong>Dental</strong> Care, PC 6162 Ridge Ave Philadelphia PA 19128 General Provider Philadelphia<br />
Nguyen Diep 000000002798 American <strong>Dental</strong> Care, PC 6162 Ridge Ave Philadelphia PA 19128 General Provider Philadelphia<br />
Oh Jinsuk 000000002798 American <strong>Dental</strong> Care, PC 6162 Ridge Ave Philadelphia PA 19128 General Provider Philadelphia<br />
Pereia Christine 000000002798 American <strong>Dental</strong> Care, PC 6162 Ridge Ave Philadelphia PA 19128 General Provider Philadelphia<br />
Roth Michael American <strong>Dental</strong> Care, PC 6162 Ridge Ave Philadelphia PA 19128 Orthodontist Philadelphia<br />
Ruggieri John 000000002798 American <strong>Dental</strong> Care, PC 6162 Ridge Ave Philadelphia PA 19128 General Provider Philadelphia<br />
Sandhu Satinder 000000002798 American <strong>Dental</strong> Care, PC 6162 Ridge Ave Philadelphia PA 19128 General Provider Philadelphia<br />
* Indicates dentist that is accepting current patients only.<br />
All <strong>Select</strong> <strong>Plan</strong> <strong>Dentist</strong>s Page 32<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 <strong>Dentist</strong>. Fac ID is used to indicate which facility a member chooses.
SELECT PLAN 1 DENTIST DIRECTORY<br />
<strong>Dentist</strong>s listed are under contract as of 9/1/12<br />
Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />
Sanfacon Dennis 000000002798 American <strong>Dental</strong> Care, PC 6162 Ridge Ave Philadelphia PA 19128 General Provider Philadelphia<br />
Shah Nishit 000000002798 American <strong>Dental</strong> Care, PC 6162 Ridge Ave Philadelphia PA 19128 General Provider Philadelphia<br />
Sultana Parveen 000000002798 American <strong>Dental</strong> Care, PC 6162 Ridge Ave Philadelphia PA 19128 General Provider Philadelphia<br />
Thilak Preetha 000000002798 American <strong>Dental</strong> Care, PC 6162 Ridge Ave Philadelphia PA 19128 General Provider Philadelphia<br />
Weinstein Steven 000000002798 American <strong>Dental</strong> Care, PC 6162 Ridge Ave Philadelphia PA 19128 General Provider Philadelphia<br />
Yang Qing 000000002798 American <strong>Dental</strong> Care, PC 6162 Ridge Ave Philadelphia PA 19128 General Provider Philadelphia<br />
Yao Zheng 000000002798 American <strong>Dental</strong> Care, PC 6162 Ridge Ave Philadelphia PA 19128 General Provider Philadelphia<br />
Yoon Simon 000000002798 American <strong>Dental</strong> Care, PC 6162 Ridge Ave Philadelphia PA 19128 General Provider Philadelphia<br />
Bresler David David A Bresler DDS PC 6801 Ridge Ave Philadelphia PA 19128 Pedodontist Philadelphia<br />
Bresler Jason David A Bresler DDS PC 6801 Ridge Ave Philadelphia PA 19128 Pedodontist Philadelphia<br />
Bresler Joshua David A Bresler DDS PC 6801 Ridge Ave Philadelphia PA 19128 Pedodontist Philadelphia<br />
Mayzenberg Julia David A Bresler DDS PC 6801 Ridge Ave Philadelphia PA 19128 Pedodontist Philadelphia<br />
Plotkin Richard Richard J. Plotkin, D.M.D. 5735 Ridge Ave Philadelphia PA 19128 Oral Surgeon Philadelphia<br />
Kim Hyosun 000000068521 East Falls Family <strong>Dentist</strong>ry 3500 Sunnyside Ave Philadelphia PA 19129 General Provider Philadelphia<br />
Abraham Kurian 000000002782 Kurian Abraham, D.D.S. 1825 Spring Garden Street Philadelphia PA 19130 General Provider Philadelphia<br />
Dempsey Renee 000000001196 <strong>Dental</strong> First Corporation 3900 Ford Rd, Suite 12 Philadelphia PA 19131 General Provider Philadelphia<br />
Berrios Karen 000000002780 Quality Community Health Center 2501 West Lehigh Ave. Philadelphia PA 19132 General Provider Philadelphia<br />
Crawford Charles 000000002780 Quality Community Health Center 2501 West Lehigh Ave. Philadelphia PA 19132 General Provider Philadelphia<br />
Frare Robert 000000002780 Quality Community Health Center 2501 West Lehigh Ave. Philadelphia PA 19132 General Provider Philadelphia<br />
Hussain Fahmida 000000002780 Quality Community Health Center 2501 West Lehigh Ave. Philadelphia PA 19132 General Provider Philadelphia<br />
Gelman Alexander 000000069951 Allegheny <strong>Dental</strong> 1 2734 E Allegheny Ave Philadelphia PA 19134 General Provider Philadelphia<br />
Khedr Maged 000000069951 Allegheny <strong>Dental</strong> 1 2734 E Allegheny Ave Philadelphia PA 19134 General Provider Philadelphia<br />
Manda Anil 000000069951 Allegheny <strong>Dental</strong> 1 2734 E Allegheny Ave Philadelphia PA 19134 General Provider Philadelphia<br />
Aranbayev Yefim 000000069970 Dentex <strong>Dental</strong> Group Ltd 2734 E Allegheny Ave Philadelphia PA 19134 General Provider Philadelphia<br />
Choi Bokyu 000000069970 Dentex <strong>Dental</strong> Group Ltd 2734 E Allegheny Ave Philadelphia PA 19134 General Provider Philadelphia<br />
Cohen Ronald 000000069970 Dentex <strong>Dental</strong> Group Ltd 2734 E Allegheny Ave Philadelphia PA 19134 General Provider Philadelphia<br />
Genkin Alexander 000000069970 Dentex <strong>Dental</strong> Group Ltd 2734 E Allegheny Ave Philadelphia PA 19134 General Provider Philadelphia<br />
Go Satoshi 000000069970 Dentex <strong>Dental</strong> Group Ltd 2734 E Allegheny Ave Philadelphia PA 19134 General Provider Philadelphia<br />
Joo Esther 000000069970 Dentex <strong>Dental</strong> Group Ltd 2734 E Allegheny Ave Philadelphia PA 19134 General Provider Philadelphia<br />
Levites Margarita 000000069970 Dentex <strong>Dental</strong> Group Ltd 2734 E Allegheny Ave Philadelphia PA 19134 General Provider Philadelphia<br />
Moon Daeuk 000000069970 Dentex <strong>Dental</strong> Group Ltd 2734 E Allegheny Ave Philadelphia PA 19134 General Provider Philadelphia<br />
Plotnik Igor 000000069970 Dentex <strong>Dental</strong> Group Ltd 2734 E Allegheny Ave Philadelphia PA 19134 General Provider Philadelphia<br />
Sedaghat Shabnam 000000069970 Dentex <strong>Dental</strong> Group Ltd 2734 E Allegheny Ave Philadelphia PA 19134 General Provider Philadelphia<br />
Zhang Chengfeng 000000069970 Dentex <strong>Dental</strong> Group Ltd 2734 E Allegheny Ave Philadelphia PA 19134 General Provider Philadelphia<br />
Zilberman Alexander 000000069970 Dentex <strong>Dental</strong> Group Ltd 2734 E Allegheny Ave Philadelphia PA 19134 General Provider Philadelphia<br />
Kondratyeva Natalya 000000001184 Magic <strong>Dental</strong> Systems 2601 E Allegheny Ave. Philadelphia PA 19134 General Provider Philadelphia<br />
Silverman Donald 000000002776 Peach <strong>Dental</strong> Center 3200 Frankford Ave Philadelphia PA 19134 General Provider Philadelphia<br />
Slutsky Harold Harold Slutsky, D.M.D. 7100 Frankford Avenue Philadelphia PA 19135 Orthodontist Philadelphia<br />
Khelmer Olga 000000079083 Mayfair <strong>Dental</strong> Center 6412 Frankford Ave, Suite 10 Philadelphia PA 19135 General Provider Philadelphia<br />
Sanjay Sowmya 000000079083 Mayfair <strong>Dental</strong> Center 6412 Frankford Ave, Suite 10 Philadelphia PA 19135 General Provider Philadelphia<br />
Barot Ashok 000000001243 Ashok Barot DDS PC 7519 Torresdale Ave Philadelphia PA 19136 General Provider Philadelphia<br />
Reddy Hima 000000001243 Ashok Barot DDS PC 7519 Torresdale Ave Philadelphia PA 19136 General Provider Philadelphia<br />
Kaye Ralph Mayfair <strong>Dental</strong> Associates, Ltd. 3541 Ryan Avenue Philadelphia PA 19136 Periodontist Philadelphia<br />
Zaim Mazharul 000000000918 Mazharul H. Zaim, D.D.S. 1915 Washington Lane Philadelphia PA 19138 General Provider Philadelphia<br />
Mehta Dhaval 000000001759 Dhaval Mehta, D.M.D. 17 S. 60th Street Philadelphia PA 19139 General Provider Philadelphia<br />
Brown Stanford 000000001427 Stanford Brown, D.D.S. 5517 Spruce Street Philadelphia PA 19139 General Provider Philadelphia<br />
Silber Stanley 000000002777 5th Street <strong>Dental</strong> Center, <strong>Inc</strong>. 4646 North 5th Street Philadelphia PA 19140 General Provider Philadelphia<br />
Aftab Nigar 000000000372 Family <strong>Dentist</strong>ry 3435 Germantown Ave. Philadelphia PA 19140 General Provider Philadelphia<br />
Dheer Nisha 000000037863 GPHA Huntington Park <strong>Dental</strong> Center 1999 W. Huntington Park Ave Philadelphia PA 19140 General Provider Philadelphia<br />
Drysdale Robert 000000037863 GPHA Huntington Park <strong>Dental</strong> Center 1999 W. Huntington Park Ave Philadelphia PA 19140 General Provider Philadelphia<br />
Elsey Riina 000000037863 GPHA Huntington Park <strong>Dental</strong> Center 1999 W. Huntington Park Ave Philadelphia PA 19140 General Provider Philadelphia<br />
Fadl Reem 000000037863 GPHA Huntington Park <strong>Dental</strong> Center 1999 W. Huntington Park Ave Philadelphia PA 19140 General Provider Philadelphia<br />
Hao Shenquan 000000037863 GPHA Huntington Park <strong>Dental</strong> Center 1999 W. Huntington Park Ave Philadelphia PA 19140 General Provider Philadelphia<br />
Jubiril-Taylor Linda 000000037863 GPHA Huntington Park <strong>Dental</strong> Center 1999 W. Huntington Park Ave Philadelphia PA 19140 General Provider Philadelphia<br />
Lloyd Arnelle 000000037863 GPHA Huntington Park <strong>Dental</strong> Center 1999 W. Huntington Park Ave Philadelphia PA 19140 General Provider Philadelphia<br />
Owens Jessica 000000037863 GPHA Huntington Park <strong>Dental</strong> Center 1999 W. Huntington Park Ave Philadelphia PA 19140 General Provider Philadelphia<br />
Bahn Paul Pediatric <strong>Dental</strong> Associates 3509 N Broad St, 6th Fl Temp Children's Med Ctr Philadelphia PA 19140 Pedodontist Philadelphia<br />
D'Agostino Alegra Pediatric <strong>Dental</strong> Associates 3509 N Broad St, 6th Fl Temp Children's Med Ctr Philadelphia PA 19140 Pedodontist Philadelphia<br />
Hamilton Sharon Pediatric <strong>Dental</strong> Associates 3509 N Broad St, 6th Fl Temp Children's Med Ctr Philadelphia PA 19140 Pedodontist Philadelphia<br />
Kay Lewis Pediatric <strong>Dental</strong> Associates 3509 N Broad St, 6th Fl Temp Children's Med Ctr Philadelphia PA 19140 Pedodontist Philadelphia<br />
Quinn Noah Pediatric <strong>Dental</strong> Associates 3509 N Broad St, 6th Fl Temp Children's Med Ctr Philadelphia PA 19140 Pedodontist Philadelphia<br />
Rosenbaum Michael Pediatric <strong>Dental</strong> Associates 3509 N Broad St, 6th Fl Temp Children's Med Ctr Philadelphia PA 19140 Pedodontist Philadelphia<br />
Thomas Kimberly Pediatric <strong>Dental</strong> Associates 3509 N Broad St, 6th Fl Temp Children's Med Ctr Philadelphia PA 19140 Pedodontist Philadelphia<br />
Patel Mukund 000000001204 Mukund K. Patel, D.D.S., P.C. 4832 N Broad Street Philadelphia PA 19141 General Provider Philadelphia<br />
Malik Arif 000000000853 Arif S. Malik, D.D.S. 6412 Woodland Ave. Philadelphia PA 19142 General Provider Philadelphia<br />
Addiego Ben Harold H. Marcus Associates 7215 W. Passyunk Ave Philadelphia PA 19142 Orthodontist Philadelphia<br />
* Indicates dentist that is accepting current patients only.<br />
All <strong>Select</strong> <strong>Plan</strong> <strong>Dentist</strong>s Page 33<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 <strong>Dentist</strong>. Fac ID is used to indicate which facility a member chooses.
SELECT PLAN 1 DENTIST DIRECTORY<br />
<strong>Dentist</strong>s listed are under contract as of 9/1/12<br />
Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />
Marcus Harold 000000000968 Harold H. Marcus Associates 7215 W. Passyunk Ave Philadelphia PA 19142 General Provider Philadelphia<br />
Marcus Joni 000000000968 Harold H. Marcus Associates 7215 W. Passyunk Ave Philadelphia PA 19142 General Provider Philadelphia<br />
Dheer Nisha 000000051121 GPHA <strong>Dental</strong> & Behavioral Health Care 5501 Woodland Ave Philadelphia PA 19143 General Provider Philadelphia<br />
Drysdale Robert 000000051121 GPHA <strong>Dental</strong> & Behavioral Health Care 5501 Woodland Ave Philadelphia PA 19143 General Provider Philadelphia<br />
Elsey Riina 000000051121 GPHA <strong>Dental</strong> & Behavioral Health Care 5501 Woodland Ave Philadelphia PA 19143 General Provider Philadelphia<br />
Fadl Reem 000000051121 GPHA <strong>Dental</strong> & Behavioral Health Care 5501 Woodland Ave Philadelphia PA 19143 General Provider Philadelphia<br />
Hao Shenquan 000000051121 GPHA <strong>Dental</strong> & Behavioral Health Care 5501 Woodland Ave Philadelphia PA 19143 General Provider Philadelphia<br />
Jubiril-Taylor Linda 000000051121 GPHA <strong>Dental</strong> & Behavioral Health Care 5501 Woodland Ave Philadelphia PA 19143 General Provider Philadelphia<br />
Lloyd Arnelle 000000051121 GPHA <strong>Dental</strong> & Behavioral Health Care 5501 Woodland Ave Philadelphia PA 19143 General Provider Philadelphia<br />
Owens Jessica 000000051121 GPHA <strong>Dental</strong> & Behavioral Health Care 5501 Woodland Ave Philadelphia PA 19143 General Provider Philadelphia<br />
Vaidya Kanchan 000000000860 Kanchan C. Vaidya, D.D.S. 5635 Chester Ave. Philadelphia PA 19143 General Provider Philadelphia<br />
Larose Chenet 000000070471 Dr Chenet Larose <strong>Dental</strong> Office 5555 Wissahickon Ave, Suite L10 Philadelphia PA 19144 General Provider Philadelphia<br />
* Varnadore Wayne 000000001337 Family and Implant <strong>Dentist</strong>ry 633 W. Rittenhouse St., C-15 Philadelphia PA 19144 General Provider Philadelphia<br />
Wood Robert 000000070455 Robert Wood DDS 5521 Greene St Philadelphia PA 19144 General Provider Philadelphia<br />
Bresler David David A Bresler DDS PC 1430 Snyder Ave Philadelphia PA 19145 Pedodontist Philadelphia<br />
Bresler Jason David A Bresler DDS PC 1430 Snyder Ave Philadelphia PA 19145 Pedodontist Philadelphia<br />
Bresler Joshua David A Bresler DDS PC 1430 Snyder Ave Philadelphia PA 19145 Pedodontist Philadelphia<br />
Mayzenberg Julia David A Bresler DDS PC 1430 Snyder Ave Philadelphia PA 19145 Pedodontist Philadelphia<br />
Warshowsky Dennis 000000001042 Dennis Warshowsky, D.M.D. 1638 South 20th St. Philadelphia PA 19145 General Provider Philadelphia<br />
Libou Keith 000000000619 Gentle <strong>Dental</strong> of Oregon LLC 1419 W Oregon Ave Philadelphia PA 19145 General Provider Philadelphia<br />
Truong Anne 000000000619 Gentle <strong>Dental</strong> of Oregon LLC 1419 W Oregon Ave Philadelphia PA 19145 General Provider Philadelphia<br />
Dheer Nisha 000000037864 GPHA Wilson Park <strong>Dental</strong> Center 2520 Snyder Ave Philadelphia PA 19145 General Provider Philadelphia<br />
Drysdale Robert 000000037864 GPHA Wilson Park <strong>Dental</strong> Center 2520 Snyder Ave Philadelphia PA 19145 General Provider Philadelphia<br />
Elsey Riina 000000037864 GPHA Wilson Park <strong>Dental</strong> Center 2520 Snyder Ave Philadelphia PA 19145 General Provider Philadelphia<br />
Fadl Reem 000000037864 GPHA Wilson Park <strong>Dental</strong> Center 2520 Snyder Ave Philadelphia PA 19145 General Provider Philadelphia<br />
Hao Shenquan 000000037864 GPHA Wilson Park <strong>Dental</strong> Center 2520 Snyder Ave Philadelphia PA 19145 General Provider Philadelphia<br />
Jubiril-Taylor Linda 000000037864 GPHA Wilson Park <strong>Dental</strong> Center 2520 Snyder Ave Philadelphia PA 19145 General Provider Philadelphia<br />
Lloyd Arnelle 000000037864 GPHA Wilson Park <strong>Dental</strong> Center 2520 Snyder Ave Philadelphia PA 19145 General Provider Philadelphia<br />
Owens Jessica 000000037864 GPHA Wilson Park <strong>Dental</strong> Center 2520 Snyder Ave Philadelphia PA 19145 General Provider Philadelphia<br />
Bahram Ramin Oral Surgery Consultants of PA 2546 South Broad Street Philadelphia PA 19145 Oral Surgeon Philadelphia<br />
Bowser Daniel Oral Surgery Consultants of PA 2546 South Broad Street Philadelphia PA 19145 Oral Surgeon Philadelphia<br />
Richman Brad Oral Surgery Consultants of PA 2546 South Broad Street Philadelphia PA 19145 Oral Surgeon Philadelphia<br />
Cohen Molly 000000069556 Steven Shipon DDS 22265 S Broad St Philadelphia PA 19145 General Provider Philadelphia<br />
Shipon Steven 000000069556 Steven Shipon DDS 22265 S Broad St Philadelphia PA 19145 General Provider Philadelphia<br />
Chae Jae 000000078263 City <strong>Dental</strong> LLC 1100 Washington Avenue, 2nd Floor, Unit G Philadelphia PA 19147 General Provider Philadelphia<br />
Dheer Nisha 000000051101 GPHA Chinatown <strong>Dental</strong> Center 930 Washington Ave Philadelphia PA 19147 General Provider Philadelphia<br />
Drysdale Robert 000000051101 GPHA Chinatown <strong>Dental</strong> Center 930 Washington Ave Philadelphia PA 19147 General Provider Philadelphia<br />
Elsey Riina 000000051101 GPHA Chinatown <strong>Dental</strong> Center 930 Washington Ave Philadelphia PA 19147 General Provider Philadelphia<br />
Fadl Reem 000000051101 GPHA Chinatown <strong>Dental</strong> Center 930 Washington Ave Philadelphia PA 19147 General Provider Philadelphia<br />
Hao Shenquan 000000051101 GPHA Chinatown <strong>Dental</strong> Center 930 Washington Ave Philadelphia PA 19147 General Provider Philadelphia<br />
Jubiril-Taylor Linda 000000051101 GPHA Chinatown <strong>Dental</strong> Center 930 Washington Ave Philadelphia PA 19147 General Provider Philadelphia<br />
Lloyd Arnelle 000000051101 GPHA Chinatown <strong>Dental</strong> Center 930 Washington Ave Philadelphia PA 19147 General Provider Philadelphia<br />
Owens Jessica 000000051101 GPHA Chinatown <strong>Dental</strong> Center 930 Washington Ave Philadelphia PA 19147 General Provider Philadelphia<br />
Ni Hong 000000051087 Nice Care <strong>Dental</strong> 1311 South St Philadelphia PA 19147 General Provider Philadelphia<br />
* Zalavadia Nikunj 000000050537 Afton Family <strong>Dental</strong> 1815 S Broad St Philadelphia PA 19148 General Provider Philadelphia<br />
Aranbayev Yefim 000000069965 Dentex <strong>Dental</strong> Group Ltd 1701 E Moyamensing Ave Philadelphia PA 19148 General Provider Philadelphia<br />
Aranbayev Yefim 000000069967 Dentex <strong>Dental</strong> Group Ltd 826 W Porter St Philadelphia PA 19148 General Provider Philadelphia<br />
Choi Bokyu 000000069965 Dentex <strong>Dental</strong> Group Ltd 1701 E Moyamensing Ave Philadelphia PA 19148 General Provider Philadelphia<br />
Choi Bokyu 000000069967 Dentex <strong>Dental</strong> Group Ltd 826 W Porter St Philadelphia PA 19148 General Provider Philadelphia<br />
Cohen Ronald 000000069965 Dentex <strong>Dental</strong> Group Ltd 1701 E Moyamensing Ave Philadelphia PA 19148 General Provider Philadelphia<br />
Cohen Ronald 000000069967 Dentex <strong>Dental</strong> Group Ltd 826 W Porter St Philadelphia PA 19148 General Provider Philadelphia<br />
Genkin Alexander 000000069965 Dentex <strong>Dental</strong> Group Ltd 1701 E Moyamensing Ave Philadelphia PA 19148 General Provider Philadelphia<br />
Genkin Alexander 000000069967 Dentex <strong>Dental</strong> Group Ltd 826 W Porter St Philadelphia PA 19148 General Provider Philadelphia<br />
Go Satoshi 000000069965 Dentex <strong>Dental</strong> Group Ltd 1701 E Moyamensing Ave Philadelphia PA 19148 General Provider Philadelphia<br />
Go Satoshi 000000069967 Dentex <strong>Dental</strong> Group Ltd 826 W Porter St Philadelphia PA 19148 General Provider Philadelphia<br />
Joo Esther 000000069965 Dentex <strong>Dental</strong> Group Ltd 1701 E Moyamensing Ave Philadelphia PA 19148 General Provider Philadelphia<br />
Joo Esther 000000069967 Dentex <strong>Dental</strong> Group Ltd 826 W Porter St Philadelphia PA 19148 General Provider Philadelphia<br />
Kim Nari 000000069965 Dentex <strong>Dental</strong> Group Ltd 1701 E Moyamensing Ave Philadelphia PA 19148 General Provider Philadelphia<br />
Kim Nari 000000069967 Dentex <strong>Dental</strong> Group Ltd 826 W Porter St Philadelphia PA 19148 General Provider Philadelphia<br />
Levites Margarita 000000069965 Dentex <strong>Dental</strong> Group Ltd 1701 E Moyamensing Ave Philadelphia PA 19148 General Provider Philadelphia<br />
Levites Margarita 000000069967 Dentex <strong>Dental</strong> Group Ltd 826 W Porter St Philadelphia PA 19148 General Provider Philadelphia<br />
Moon Daeuk 000000069965 Dentex <strong>Dental</strong> Group Ltd 1701 E Moyamensing Ave Philadelphia PA 19148 General Provider Philadelphia<br />
Moon Daeuk 000000069967 Dentex <strong>Dental</strong> Group Ltd 826 W Porter St Philadelphia PA 19148 General Provider Philadelphia<br />
Plotnik Igor 000000069965 Dentex <strong>Dental</strong> Group Ltd 1701 E Moyamensing Ave Philadelphia PA 19148 General Provider Philadelphia<br />
Plotnik Igor 000000069967 Dentex <strong>Dental</strong> Group Ltd 826 W Porter St Philadelphia PA 19148 General Provider Philadelphia<br />
Sedaghat Shabnam 000000069965 Dentex <strong>Dental</strong> Group Ltd 1701 E Moyamensing Ave Philadelphia PA 19148 General Provider Philadelphia<br />
* Indicates dentist that is accepting current patients only.<br />
All <strong>Select</strong> <strong>Plan</strong> <strong>Dentist</strong>s Page 34<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 <strong>Dentist</strong>. Fac ID is used to indicate which facility a member chooses.
SELECT PLAN 1 DENTIST DIRECTORY<br />
<strong>Dentist</strong>s listed are under contract as of 9/1/12<br />
Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />
Sedaghat Shabnam 000000069967 Dentex <strong>Dental</strong> Group Ltd 826 W Porter St Philadelphia PA 19148 General Provider Philadelphia<br />
Zhang Chengfeng 000000069965 Dentex <strong>Dental</strong> Group Ltd 1701 E Moyamensing Ave Philadelphia PA 19148 General Provider Philadelphia<br />
Zhang Chengfeng 000000069967 Dentex <strong>Dental</strong> Group Ltd 826 W Porter St Philadelphia PA 19148 General Provider Philadelphia<br />
Zilberman Alexander 000000069965 Dentex <strong>Dental</strong> Group Ltd 1701 E Moyamensing Ave Philadelphia PA 19148 General Provider Philadelphia<br />
Zilberman Alexander 000000069967 Dentex <strong>Dental</strong> Group Ltd 826 W Porter St Philadelphia PA 19148 General Provider Philadelphia<br />
Dheer Nisha 000000037865 GPHA Snyder Avenue <strong>Dental</strong> Center 640 Snyder Ave Philadelphia PA 19148 General Provider Philadelphia<br />
Drysdale Robert 000000037865 GPHA Snyder Avenue <strong>Dental</strong> Center 640 Snyder Ave Philadelphia PA 19148 General Provider Philadelphia<br />
Elsey Riina 000000037865 GPHA Snyder Avenue <strong>Dental</strong> Center 640 Snyder Ave Philadelphia PA 19148 General Provider Philadelphia<br />
Fadl Reem 000000037865 GPHA Snyder Avenue <strong>Dental</strong> Center 640 Snyder Ave Philadelphia PA 19148 General Provider Philadelphia<br />
Hao Shenquan 000000037865 GPHA Snyder Avenue <strong>Dental</strong> Center 640 Snyder Ave Philadelphia PA 19148 General Provider Philadelphia<br />
Jubiril-Taylor Linda 000000037865 GPHA Snyder Avenue <strong>Dental</strong> Center 640 Snyder Ave Philadelphia PA 19148 General Provider Philadelphia<br />
Lloyd Arnelle 000000037865 GPHA Snyder Avenue <strong>Dental</strong> Center 640 Snyder Ave Philadelphia PA 19148 General Provider Philadelphia<br />
Owens Jessica 000000037865 GPHA Snyder Avenue <strong>Dental</strong> Center 640 Snyder Ave Philadelphia PA 19148 General Provider Philadelphia<br />
Iheoma Esochi 000000069568 Jeso Advanced Family <strong>Dentist</strong>ry 223 A McClellan St Philadelphia PA 19148 General Provider Philadelphia<br />
Lavalla James 000000068493 Smile Care Center 626 Snyder Ave Philadelphia PA 19148 General Provider Philadelphia<br />
Marisiddaiah Satish 000000068493 Smile Care Center 626 Snyder Ave Philadelphia PA 19148 General Provider Philadelphia<br />
O'Reilly Maria Smile Care Center 626 Snyder Ave Philadelphia PA 19148 Orthodontist Philadelphia<br />
Thurber John 000000068493 Smile Care Center 626 Snyder Ave Philadelphia PA 19148 General Provider Philadelphia<br />
Alten Steven 000000000494 Steven B Alten, DDS 2529 South Fifth Street Philadelphia PA 19148 General Provider Philadelphia<br />
Bruno Frank Steven Shipon DDS Specialists 22265 S Broad St Philadelphia PA 19148 Endodontist Philadelphia<br />
Cichetti Michael Cichetti & DelliGatti Orthodontics PC 6404 Roosevelt Blvd, 2nd Floor Philadelphia PA 19149 Orthodontist Philadelphia<br />
DelliGatti Steve Cichetti & DelliGatti Orthodontics PC 6404 Roosevelt Blvd, 2nd Floor Philadelphia PA 19149 Orthodontist Philadelphia<br />
Milewski Michael Cichetti & DelliGatti Orthodontics PC 6404 Roosevelt Blvd, 2nd Floor Philadelphia PA 19149 Orthodontist Philadelphia<br />
Orozco Jacob Cichetti & DelliGatti Orthodontics PC 6404 Roosevelt Blvd, 2nd Floor Philadelphia PA 19149 Orthodontist Philadelphia<br />
Liss Ira 000000000369 Longshore Family <strong>Dentist</strong>ry 2001 Longshore Ave. Philadelphia PA 19149 General Provider Philadelphia<br />
Bahn Paul Pediatric <strong>Dental</strong> Associates 6404 Roosevelt Blvd Philadelphia PA 19149 Pedodontist Philadelphia<br />
D'Agostino Alegra Pediatric <strong>Dental</strong> Associates 6404 Roosevelt Blvd Philadelphia PA 19149 Pedodontist Philadelphia<br />
Hamilton Sharon Pediatric <strong>Dental</strong> Associates 6404 Roosevelt Blvd Philadelphia PA 19149 Pedodontist Philadelphia<br />
Kay Lewis Pediatric <strong>Dental</strong> Associates 6404 Roosevelt Blvd Philadelphia PA 19149 Pedodontist Philadelphia<br />
Quinn Noah Pediatric <strong>Dental</strong> Associates 6404 Roosevelt Blvd Philadelphia PA 19149 Pedodontist Philadelphia<br />
Rosenbaum Michael Pediatric <strong>Dental</strong> Associates 6404 Roosevelt Blvd Philadelphia PA 19149 Pedodontist Philadelphia<br />
Thomas Kimberly Pediatric <strong>Dental</strong> Associates 6404 Roosevelt Blvd Philadelphia PA 19149 Pedodontist Philadelphia<br />
Barot Ashok 000000079783 Revere <strong>Dental</strong> 7265 Revere St Philadelphia PA 19149 General Provider Philadelphia<br />
He Yuling 000000079783 Revere <strong>Dental</strong> 7265 Revere St Philadelphia PA 19149 General Provider Philadelphia<br />
Jeong Jihyon 000000079783 Revere <strong>Dental</strong> 7265 Revere St Philadelphia PA 19149 General Provider Philadelphia<br />
Patmidi Avanti 000000079783 Revere <strong>Dental</strong> 7265 Revere St Philadelphia PA 19149 General Provider Philadelphia<br />
Rotwein Benjamin 000000079783 Revere <strong>Dental</strong> 7265 Revere St Philadelphia PA 19149 General Provider Philadelphia<br />
Tadisena Archana 000000079783 Revere <strong>Dental</strong> 7265 Revere St Philadelphia PA 19149 General Provider Philadelphia<br />
Agrawal Avanti 000000072089 Advanced Family <strong>Dentist</strong>ry PC 2630 W Cheltenham Ave Philadelphia PA 19150 General Provider Philadelphia<br />
Derosa Daniel 000000072089 Advanced Family <strong>Dentist</strong>ry PC 2630 W Cheltenham Ave Philadelphia PA 19150 General Provider Philadelphia<br />
Kim Angie 000000072089 Advanced Family <strong>Dentist</strong>ry PC 2630 W Cheltenham Ave Philadelphia PA 19150 General Provider Philadelphia<br />
Savani Bhaskar 000000072089 Advanced Family <strong>Dentist</strong>ry PC 2630 W Cheltenham Ave Philadelphia PA 19150 General Provider Philadelphia<br />
Savani Niranjan 000000072089 Advanced Family <strong>Dentist</strong>ry PC 2630 W Cheltenham Ave Philadelphia PA 19150 General Provider Philadelphia<br />
Todd Meredith 000000072089 Advanced Family <strong>Dentist</strong>ry PC 2630 W Cheltenham Ave Philadelphia PA 19150 General Provider Philadelphia<br />
Adams Michael 000000051002 American <strong>Dental</strong> Care, PC 1501 Wadsworth Ave Philadelphia PA 19150 General Provider Philadelphia<br />
Adams Michael 000000002793 American <strong>Dental</strong> Care, PC 2385 Cheltenham Ave, Cheltenham Square Mall Philadelphia PA 19150 General Provider Philadelphia<br />
Bruno Frank American <strong>Dental</strong> Care, PC 1501 Wadsworth Ave Philadelphia PA 19150 Endodontist Philadelphia<br />
Bruno Frank American <strong>Dental</strong> Care, PC 2385 Cheltenham Ave, Cheltenham Square Mall Philadelphia PA 19150 Endodontist Philadelphia<br />
Chen Yang 000000051002 American <strong>Dental</strong> Care, PC 1501 Wadsworth Ave Philadelphia PA 19150 General Provider Philadelphia<br />
Chen Yang 000000002793 American <strong>Dental</strong> Care, PC 2385 Cheltenham Ave, Cheltenham Square Mall Philadelphia PA 19150 General Provider Philadelphia<br />
Cohen Hal 000000051002 American <strong>Dental</strong> Care, PC 1501 Wadsworth Ave Philadelphia PA 19150 General Provider Philadelphia<br />
Cohen Hal 000000002793 American <strong>Dental</strong> Care, PC 2385 Cheltenham Ave, Cheltenham Square Mall Philadelphia PA 19150 General Provider Philadelphia<br />
Daly Gerald 000000051002 American <strong>Dental</strong> Care, PC 1501 Wadsworth Ave Philadelphia PA 19150 General Provider Philadelphia<br />
Daly Gerald 000000002793 American <strong>Dental</strong> Care, PC 2385 Cheltenham Ave, Cheltenham Square Mall Philadelphia PA 19150 General Provider Philadelphia<br />
David Dan 000000051002 American <strong>Dental</strong> Care, PC 1501 Wadsworth Ave Philadelphia PA 19150 General Provider Philadelphia<br />
David Dan 000000002793 American <strong>Dental</strong> Care, PC 2385 Cheltenham Ave, Cheltenham Square Mall Philadelphia PA 19150 General Provider Philadelphia<br />
Edmonds R Blake 000000051002 American <strong>Dental</strong> Care, PC 1501 Wadsworth Ave Philadelphia PA 19150 General Provider Philadelphia<br />
Edmonds R Blake 000000002793 American <strong>Dental</strong> Care, PC 2385 Cheltenham Ave, Cheltenham Square Mall Philadelphia PA 19150 General Provider Philadelphia<br />
Elkhatib Mohammad 000000051002 American <strong>Dental</strong> Care, PC 1501 Wadsworth Ave Philadelphia PA 19150 General Provider Philadelphia<br />
Elkhatib Mohammad 000000002793 American <strong>Dental</strong> Care, PC 2385 Cheltenham Ave, Cheltenham Square Mall Philadelphia PA 19150 General Provider Philadelphia<br />
Fluhr Howard 000000051002 American <strong>Dental</strong> Care, PC 1501 Wadsworth Ave Philadelphia PA 19150 General Provider Philadelphia<br />
Fluhr Howard 000000002793 American <strong>Dental</strong> Care, PC 2385 Cheltenham Ave, Cheltenham Square Mall Philadelphia PA 19150 General Provider Philadelphia<br />
Gelbart Steven 000000051002 American <strong>Dental</strong> Care, PC 1501 Wadsworth Ave Philadelphia PA 19150 General Provider Philadelphia<br />
Gelbart Steven 000000002793 American <strong>Dental</strong> Care, PC 2385 Cheltenham Ave, Cheltenham Square Mall Philadelphia PA 19150 General Provider Philadelphia<br />
Kim Jae Woo 000000051002 American <strong>Dental</strong> Care, PC 1501 Wadsworth Ave Philadelphia PA 19150 General Provider Philadelphia<br />
Kim Jae Woo 000000002793 American <strong>Dental</strong> Care, PC 2385 Cheltenham Ave, Cheltenham Square Mall Philadelphia PA 19150 General Provider Philadelphia<br />
* Indicates dentist that is accepting current patients only.<br />
All <strong>Select</strong> <strong>Plan</strong> <strong>Dentist</strong>s Page 35<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 <strong>Dentist</strong>. Fac ID is used to indicate which facility a member chooses.
SELECT PLAN 1 DENTIST DIRECTORY<br />
<strong>Dentist</strong>s listed are under contract as of 9/1/12<br />
Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />
Kim Steven American <strong>Dental</strong> Care, PC 1501 Wadsworth Ave Philadelphia PA 19150 Periodontist Philadelphia<br />
Kim Steven American <strong>Dental</strong> Care, PC 2385 Cheltenham Ave, Cheltenham Square Mall Philadelphia PA 19150 Periodontist Philadelphia<br />
Koff Howard American <strong>Dental</strong> Care, PC 1501 Wadsworth Ave Philadelphia PA 19150 Orthodontist Philadelphia<br />
Koff Howard American <strong>Dental</strong> Care, PC 2385 Cheltenham Ave, Cheltenham Square Mall Philadelphia PA 19150 Orthodontist Philadelphia<br />
Levy Jamie American <strong>Dental</strong> Care, PC 1501 Wadsworth Ave Philadelphia PA 19150 Oral Surgeon Philadelphia<br />
Levy Jamie American <strong>Dental</strong> Care, PC 2385 Cheltenham Ave, Cheltenham Square Mall Philadelphia PA 19150 Oral Surgeon Philadelphia<br />
Li Fuming 000000051002 American <strong>Dental</strong> Care, PC 1501 Wadsworth Ave Philadelphia PA 19150 General Provider Philadelphia<br />
Li Fuming 000000002793 American <strong>Dental</strong> Care, PC 2385 Cheltenham Ave, Cheltenham Square Mall Philadelphia PA 19150 General Provider Philadelphia<br />
Lu John American <strong>Dental</strong> Care, PC 1501 Wadsworth Ave Philadelphia PA 19150 Periodontist Philadelphia<br />
Lu John American <strong>Dental</strong> Care, PC 2385 Cheltenham Ave, Cheltenham Square Mall Philadelphia PA 19150 Periodontist Philadelphia<br />
Mojahed Amir 000000051002 American <strong>Dental</strong> Care, PC 1501 Wadsworth Ave Philadelphia PA 19150 General Provider Philadelphia<br />
Mojahed Amir 000000002793 American <strong>Dental</strong> Care, PC 2385 Cheltenham Ave, Cheltenham Square Mall Philadelphia PA 19150 General Provider Philadelphia<br />
Mumtaz Samera 000000051002 American <strong>Dental</strong> Care, PC 1501 Wadsworth Ave Philadelphia PA 19150 General Provider Philadelphia<br />
Mumtaz Samera 000000002793 American <strong>Dental</strong> Care, PC 2385 Cheltenham Ave, Cheltenham Square Mall Philadelphia PA 19150 General Provider Philadelphia<br />
Nguyen Diep 000000051002 American <strong>Dental</strong> Care, PC 1501 Wadsworth Ave Philadelphia PA 19150 General Provider Philadelphia<br />
Nguyen Diep 000000002793 American <strong>Dental</strong> Care, PC 2385 Cheltenham Ave, Cheltenham Square Mall Philadelphia PA 19150 General Provider Philadelphia<br />
Oh Jinsuk 000000051002 American <strong>Dental</strong> Care, PC 1501 Wadsworth Ave Philadelphia PA 19150 General Provider Philadelphia<br />
Oh Jinsuk 000000002793 American <strong>Dental</strong> Care, PC 2385 Cheltenham Ave, Cheltenham Square Mall Philadelphia PA 19150 General Provider Philadelphia<br />
Pereia Christine 000000051002 American <strong>Dental</strong> Care, PC 1501 Wadsworth Ave Philadelphia PA 19150 General Provider Philadelphia<br />
Pereia Christine 000000002793 American <strong>Dental</strong> Care, PC 2385 Cheltenham Ave, Cheltenham Square Mall Philadelphia PA 19150 General Provider Philadelphia<br />
Roth Michael American <strong>Dental</strong> Care, PC 1501 Wadsworth Ave Philadelphia PA 19150 Orthodontist Philadelphia<br />
Roth Michael American <strong>Dental</strong> Care, PC 2385 Cheltenham Ave, Cheltenham Square Mall Philadelphia PA 19150 Orthodontist Philadelphia<br />
Ruggieri John 000000051002 American <strong>Dental</strong> Care, PC 1501 Wadsworth Ave Philadelphia PA 19150 General Provider Philadelphia<br />
Ruggieri John 000000002793 American <strong>Dental</strong> Care, PC 2385 Cheltenham Ave, Cheltenham Square Mall Philadelphia PA 19150 General Provider Philadelphia<br />
Sandhu Satinder 000000051002 American <strong>Dental</strong> Care, PC 1501 Wadsworth Ave Philadelphia PA 19150 General Provider Philadelphia<br />
Sandhu Satinder 000000002793 American <strong>Dental</strong> Care, PC 2385 Cheltenham Ave, Cheltenham Square Mall Philadelphia PA 19150 General Provider Philadelphia<br />
Sanfacon Dennis 000000002793 American <strong>Dental</strong> Care, PC 2385 Cheltenham Ave, Cheltenham Square Mall Philadelphia PA 19150 General Provider Philadelphia<br />
Shah Nishit 000000051002 American <strong>Dental</strong> Care, PC 1501 Wadsworth Ave Philadelphia PA 19150 General Provider Philadelphia<br />
Shah Nishit 000000002793 American <strong>Dental</strong> Care, PC 2385 Cheltenham Ave, Cheltenham Square Mall Philadelphia PA 19150 General Provider Philadelphia<br />
Shamseddin Seyed American <strong>Dental</strong> Care, PC 1501 Wadsworth Ave Philadelphia PA 19150 Periodontist Philadelphia<br />
Shamseddin Seyed American <strong>Dental</strong> Care, PC 2385 Cheltenham Ave, Cheltenham Square Mall Philadelphia PA 19150 Periodontist Philadelphia<br />
Sultana Parveen 000000051002 American <strong>Dental</strong> Care, PC 1501 Wadsworth Ave Philadelphia PA 19150 General Provider Philadelphia<br />
Sultana Parveen 000000002793 American <strong>Dental</strong> Care, PC 2385 Cheltenham Ave, Cheltenham Square Mall Philadelphia PA 19150 General Provider Philadelphia<br />
Thilak Preetha 000000051002 American <strong>Dental</strong> Care, PC 1501 Wadsworth Ave Philadelphia PA 19150 General Provider Philadelphia<br />
Thilak Preetha 000000002793 American <strong>Dental</strong> Care, PC 2385 Cheltenham Ave, Cheltenham Square Mall Philadelphia PA 19150 General Provider Philadelphia<br />
Weinstein Steven 000000051002 American <strong>Dental</strong> Care, PC 1501 Wadsworth Ave Philadelphia PA 19150 General Provider Philadelphia<br />
Weinstein Steven 000000002793 American <strong>Dental</strong> Care, PC 2385 Cheltenham Ave, Cheltenham Square Mall Philadelphia PA 19150 General Provider Philadelphia<br />
Yang Qing 000000051002 American <strong>Dental</strong> Care, PC 1501 Wadsworth Ave Philadelphia PA 19150 General Provider Philadelphia<br />
Yang Qing 000000002793 American <strong>Dental</strong> Care, PC 2385 Cheltenham Ave, Cheltenham Square Mall Philadelphia PA 19150 General Provider Philadelphia<br />
Yao Zheng 000000051002 American <strong>Dental</strong> Care, PC 1501 Wadsworth Ave Philadelphia PA 19150 General Provider Philadelphia<br />
Yao Zheng 000000002793 American <strong>Dental</strong> Care, PC 2385 Cheltenham Ave, Cheltenham Square Mall Philadelphia PA 19150 General Provider Philadelphia<br />
Yoon Simon 000000051002 American <strong>Dental</strong> Care, PC 1501 Wadsworth Ave Philadelphia PA 19150 General Provider Philadelphia<br />
Yoon Simon 000000002793 American <strong>Dental</strong> Care, PC 2385 Cheltenham Ave, Cheltenham Square Mall Philadelphia PA 19150 General Provider Philadelphia<br />
Appiah-Forson Joseph 000000002191 Joseph Appiah-Forson, D.M.D., MAGD 7901 Limekiln Pike Philadelphia PA 19150 General Provider Philadelphia<br />
Chadhalavada Kavitha 000000068448 Eastern <strong>Dental</strong> Associates of Overbrook 2121 N 63rd Street Philadelphia PA 19151 General Provider Philadelphia<br />
Panossian Antoine A+ Oral Surgery Specialty Care PC 8355 Loretto Ave, Suite 104 Philadelphia PA 19152 Oral Surgeon Philadelphia<br />
Bandelac Georges A+ Periodontic Specialty Care PC 8001 Roosevelt Blvd, Suite 503 Philadelphia PA 19152 Periodontist Philadelphia<br />
Bandelac Georges A+ Periodontic Specialty Care PC 8355 Loretto Ave, Suite 104 Philadelphia PA 19152 Periodontist Philadelphia<br />
Bandelac Georges A+ Periodontic Specialty Care PC 8539 Bustleton Ave Philadelphia PA 19152 Periodontist Philadelphia<br />
Evans Marianna A+ Periodontic Specialty Care PC 8001 Roosevelt Blvd, Suite 503 Philadelphia PA 19152 Periodontist Philadelphia<br />
Evans Marianna A+ Periodontic Specialty Care PC 8355 Loretto Ave, Suite 104 Philadelphia PA 19152 Periodontist Philadelphia<br />
Evans Marianna A+ Periodontic Specialty Care PC 8539 Bustleton Ave Philadelphia PA 19152 Periodontist Philadelphia<br />
Agrawal Avanti 000000050384 A-1 Family <strong>Dental</strong> Care PC 8001 Roosevelt Blvd, Suite 503 Philadelphia PA 19152 General Provider Philadelphia<br />
Agrawal Avanti 000000002351 A-1 Family <strong>Dental</strong> Care PC 8355 Loretto Avenue, Suite 104 Philadelphia PA 19152 General Provider Philadelphia<br />
Agrawal Avanti 000000000392 A-1 Family <strong>Dental</strong> Care PC 8539 Bustleton Ave. Philadelphia PA 19152 General Provider Philadelphia<br />
Ahmadzadeh Bijan 000000050384 A-1 Family <strong>Dental</strong> Care PC 8001 Roosevelt Blvd, Suite 503 Philadelphia PA 19152 General Provider Philadelphia<br />
Ahmadzadeh Bijan 000000002351 A-1 Family <strong>Dental</strong> Care PC 8355 Loretto Avenue, Suite 104 Philadelphia PA 19152 General Provider Philadelphia<br />
Ahmadzadeh Bijan 000000000392 A-1 Family <strong>Dental</strong> Care PC 8539 Bustleton Ave. Philadelphia PA 19152 General Provider Philadelphia<br />
Dapkute Ingrida 000000050384 A-1 Family <strong>Dental</strong> Care PC 8001 Roosevelt Blvd, Suite 503 Philadelphia PA 19152 General Provider Philadelphia<br />
Dapkute Ingrida 000000002351 A-1 Family <strong>Dental</strong> Care PC 8355 Loretto Avenue, Suite 104 Philadelphia PA 19152 General Provider Philadelphia<br />
Dapkute Ingrida 000000000392 A-1 Family <strong>Dental</strong> Care PC 8539 Bustleton Ave. Philadelphia PA 19152 General Provider Philadelphia<br />
Derosa Daniel 000000050384 A-1 Family <strong>Dental</strong> Care PC 8001 Roosevelt Blvd, Suite 503 Philadelphia PA 19152 General Provider Philadelphia<br />
Derosa Daniel 000000002351 A-1 Family <strong>Dental</strong> Care PC 8355 Loretto Avenue, Suite 104 Philadelphia PA 19152 General Provider Philadelphia<br />
Derosa Daniel 000000000392 A-1 Family <strong>Dental</strong> Care PC 8539 Bustleton Ave. Philadelphia PA 19152 General Provider Philadelphia<br />
Gobron Adina 000000050384 A-1 Family <strong>Dental</strong> Care PC 8001 Roosevelt Blvd, Suite 503 Philadelphia PA 19152 General Provider Philadelphia<br />
Gobron Adina 000000002351 A-1 Family <strong>Dental</strong> Care PC 8355 Loretto Avenue, Suite 104 Philadelphia PA 19152 General Provider Philadelphia<br />
* Indicates dentist that is accepting current patients only.<br />
All <strong>Select</strong> <strong>Plan</strong> <strong>Dentist</strong>s Page 36<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 <strong>Dentist</strong>. Fac ID is used to indicate which facility a member chooses.
SELECT PLAN 1 DENTIST DIRECTORY<br />
<strong>Dentist</strong>s listed are under contract as of 9/1/12<br />
Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />
Gobron Adina 000000000392 A-1 Family <strong>Dental</strong> Care PC 8539 Bustleton Ave. Philadelphia PA 19152 General Provider Philadelphia<br />
Kim Angie 000000000392 A-1 Family <strong>Dental</strong> Care PC 8539 Bustleton Ave. Philadelphia PA 19152 General Provider Philadelphia<br />
Kopp Anatoliy 000000050384 A-1 Family <strong>Dental</strong> Care PC 8001 Roosevelt Blvd, Suite 503 Philadelphia PA 19152 General Provider Philadelphia<br />
Merin Jared 000000050384 A-1 Family <strong>Dental</strong> Care PC 8001 Roosevelt Blvd, Suite 503 Philadelphia PA 19152 General Provider Philadelphia<br />
Merin Jared 000000002351 A-1 Family <strong>Dental</strong> Care PC 8355 Loretto Avenue, Suite 104 Philadelphia PA 19152 General Provider Philadelphia<br />
Merin Jared 000000000392 A-1 Family <strong>Dental</strong> Care PC 8539 Bustleton Ave. Philadelphia PA 19152 General Provider Philadelphia<br />
Mitelman Alexandra 000000050384 A-1 Family <strong>Dental</strong> Care PC 8001 Roosevelt Blvd, Suite 503 Philadelphia PA 19152 General Provider Philadelphia<br />
Mitelman Alexandra 000000002351 A-1 Family <strong>Dental</strong> Care PC 8355 Loretto Avenue, Suite 104 Philadelphia PA 19152 General Provider Philadelphia<br />
Mitelman Alexandra 000000000392 A-1 Family <strong>Dental</strong> Care PC 8539 Bustleton Ave. Philadelphia PA 19152 General Provider Philadelphia<br />
Moriarty Sean 000000050384 A-1 Family <strong>Dental</strong> Care PC 8001 Roosevelt Blvd, Suite 503 Philadelphia PA 19152 General Provider Philadelphia<br />
Moriarty Sean 000000002351 A-1 Family <strong>Dental</strong> Care PC 8355 Loretto Avenue, Suite 104 Philadelphia PA 19152 General Provider Philadelphia<br />
Moriarty Sean 000000000392 A-1 Family <strong>Dental</strong> Care PC 8539 Bustleton Ave. Philadelphia PA 19152 General Provider Philadelphia<br />
Park Charlie 000000050384 A-1 Family <strong>Dental</strong> Care PC 8001 Roosevelt Blvd, Suite 503 Philadelphia PA 19152 General Provider Philadelphia<br />
Park Jikyung 000000050384 A-1 Family <strong>Dental</strong> Care PC 8001 Roosevelt Blvd, Suite 503 Philadelphia PA 19152 General Provider Philadelphia<br />
Patel Snehal 000000000392 A-1 Family <strong>Dental</strong> Care PC 8539 Bustleton Ave. Philadelphia PA 19152 General Provider Philadelphia<br />
Purtuc Cynthia 000000002351 A-1 Family <strong>Dental</strong> Care PC 8355 Loretto Avenue, Suite 104 Philadelphia PA 19152 General Provider Philadelphia<br />
Savani Bhaskar 000000050384 A-1 Family <strong>Dental</strong> Care PC 8001 Roosevelt Blvd, Suite 503 Philadelphia PA 19152 General Provider Philadelphia<br />
Savani Bhaskar 000000002351 A-1 Family <strong>Dental</strong> Care PC 8355 Loretto Avenue, Suite 104 Philadelphia PA 19152 General Provider Philadelphia<br />
Savani Bhaskar 000000000392 A-1 Family <strong>Dental</strong> Care PC 8539 Bustleton Ave. Philadelphia PA 19152 General Provider Philadelphia<br />
Savani Niranjan 000000050384 A-1 Family <strong>Dental</strong> Care PC 8001 Roosevelt Blvd, Suite 503 Philadelphia PA 19152 General Provider Philadelphia<br />
Savani Niranjan 000000002351 A-1 Family <strong>Dental</strong> Care PC 8355 Loretto Avenue, Suite 104 Philadelphia PA 19152 General Provider Philadelphia<br />
Savani Niranjan 000000000392 A-1 Family <strong>Dental</strong> Care PC 8539 Bustleton Ave. Philadelphia PA 19152 General Provider Philadelphia<br />
Todd Meredith 000000050384 A-1 Family <strong>Dental</strong> Care PC 8001 Roosevelt Blvd, Suite 503 Philadelphia PA 19152 General Provider Philadelphia<br />
Todd Meredith 000000002351 A-1 Family <strong>Dental</strong> Care PC 8355 Loretto Avenue, Suite 104 Philadelphia PA 19152 General Provider Philadelphia<br />
Todd Meredith 000000000392 A-1 Family <strong>Dental</strong> Care PC 8539 Bustleton Ave. Philadelphia PA 19152 General Provider Philadelphia<br />
Vinogradov Yelena 000000002351 A-1 Family <strong>Dental</strong> Care PC 8355 Loretto Avenue, Suite 104 Philadelphia PA 19152 General Provider Philadelphia<br />
Xu Lei 000000002351 A-1 Family <strong>Dental</strong> Care PC 8355 Loretto Avenue, Suite 104 Philadelphia PA 19152 General Provider Philadelphia<br />
Evans Marianna Allied Orthodontics PC 8355 Loretto Ave, Suite 104 Philadelphia PA 19152 Orthodontist Philadelphia<br />
Pruzansky Dawn Allied Orthodontics PC 8355 Loretto Ave, Suite 104 Philadelphia PA 19152 Orthodontist Philadelphia<br />
Kondratyeva Natalya 000000001183 Magic <strong>Dental</strong> Systems 8253 Bustleton Ave. Philadelphia PA 19152 General Provider Philadelphia<br />
Ahmadzadeh Bijan 000000050903 A-1 Family <strong>Dental</strong> Care P C 2901 Secane Drive Philadelphia PA 19154 General Provider Philadelphia<br />
Dapkute Ingrida 000000050903 A-1 Family <strong>Dental</strong> Care P C 2901 Secane Drive Philadelphia PA 19154 General Provider Philadelphia<br />
Gobron Adina 000000050903 A-1 Family <strong>Dental</strong> Care P C 2901 Secane Drive Philadelphia PA 19154 General Provider Philadelphia<br />
Merin Jared 000000050903 A-1 Family <strong>Dental</strong> Care P C 2901 Secane Drive Philadelphia PA 19154 General Provider Philadelphia<br />
Mitelman Alexandra 000000050903 A-1 Family <strong>Dental</strong> Care P C 2901 Secane Drive Philadelphia PA 19154 General Provider Philadelphia<br />
Moriarty Sean 000000050903 A-1 Family <strong>Dental</strong> Care P C 2901 Secane Drive Philadelphia PA 19154 General Provider Philadelphia<br />
Savani Bhaskar 000000050903 A-1 Family <strong>Dental</strong> Care P C 2901 Secane Drive Philadelphia PA 19154 General Provider Philadelphia<br />
Savani Niranjan 000000050903 A-1 Family <strong>Dental</strong> Care P C 2901 Secane Drive Philadelphia PA 19154 General Provider Philadelphia<br />
Agrawal Avanti 000000068500 A-1 Family <strong>Dental</strong> Care PC 12301 Academy Rd, Suite 201-202 Philadelphia PA 19154 General Provider Philadelphia<br />
Derosa Daniel 000000068500 A-1 Family <strong>Dental</strong> Care PC 12301 Academy Rd, Suite 201-202 Philadelphia PA 19154 General Provider Philadelphia<br />
Hoang Mark 000000068500 A-1 Family <strong>Dental</strong> Care PC 12301 Academy Rd, Suite 201-202 Philadelphia PA 19154 General Provider Philadelphia<br />
Purtuc Cynthia 000000068500 A-1 Family <strong>Dental</strong> Care PC 12301 Academy Rd, Suite 201-202 Philadelphia PA 19154 General Provider Philadelphia<br />
Savani Bhaskar 000000068500 A-1 Family <strong>Dental</strong> Care PC 12301 Academy Rd, Suite 201-202 Philadelphia PA 19154 General Provider Philadelphia<br />
Savani Niranjan 000000068500 A-1 Family <strong>Dental</strong> Care PC 12301 Academy Rd, Suite 201-202 Philadelphia PA 19154 General Provider Philadelphia<br />
Todd Meredith 000000068500 A-1 Family <strong>Dental</strong> Care PC 12301 Academy Rd, Suite 201-202 Philadelphia PA 19154 General Provider Philadelphia<br />
Paul Prolay 000000050726 Franklin Mills Mall <strong>Dental</strong> 1120 Franklin Mills Cir Philadelphia PA 19154 General Provider Philadelphia<br />
Shah Shreyas 000000050726 Franklin Mills Mall <strong>Dental</strong> 1120 Franklin Mills Cir Philadelphia PA 19154 General Provider Philadelphia<br />
Frankel Harvey Harvey Frankel, D.M.D. 614 S. Franklin Avenue Somerset PA 15501 Pedodontist Somerset<br />
Bott Robert 000000001228 Robert P. Bott, D.M.D. The Professional Bld, Main Street Avella PA 15312 General Provider Washington<br />
Pasqual Harry Pasqual Associates 3001 Waterdam Plaza Dr. Canonsburg PA 15317 Oral Surgeon Washington<br />
Adams William 000000001073 Katsur <strong>Dental</strong> & Orthodontics 661 McKean Avenue Donora PA 15033 General Provider Washington<br />
Affolter John 000000001073 Katsur <strong>Dental</strong> & Orthodontics 661 McKean Avenue Donora PA 15033 General Provider Washington<br />
Alagirisamy Kiruthika 000000001073 Katsur <strong>Dental</strong> & Orthodontics 661 McKean Avenue Donora PA 15033 General Provider Washington<br />
Carozza Roselyn 000000001073 Katsur <strong>Dental</strong> & Orthodontics 661 McKean Avenue Donora PA 15033 General Provider Washington<br />
Cohen Ira 000000001073 Katsur <strong>Dental</strong> & Orthodontics 661 McKean Avenue Donora PA 15033 General Provider Washington<br />
Dahar Nicholas Katsur <strong>Dental</strong> & Orthodontics 661 McKean Avenue Donora PA 15033 Orthodontist Washington<br />
Damich Louis 000000001073 Katsur <strong>Dental</strong> & Orthodontics 661 McKean Avenue Donora PA 15033 General Provider Washington<br />
Ghaffari Catherine 000000001073 Katsur <strong>Dental</strong> & Orthodontics 661 McKean Avenue Donora PA 15033 General Provider Washington<br />
Ghajarnia M. Reza Katsur <strong>Dental</strong> & Orthodontics 661 McKean Avenue Donora PA 15033 Orthodontist Washington<br />
Gillen Steve 000000001073 Katsur <strong>Dental</strong> & Orthodontics 661 McKean Avenue Donora PA 15033 General Provider Washington<br />
Iszkula Steven Katsur <strong>Dental</strong> & Orthodontics 661 McKean Avenue Donora PA 15033 Orthodontist Washington<br />
Katsur James 000000001073 Katsur <strong>Dental</strong> & Orthodontics 661 McKean Avenue Donora PA 15033 General Provider Washington<br />
Khurana Leena 000000001073 Katsur <strong>Dental</strong> & Orthodontics 661 McKean Avenue Donora PA 15033 General Provider Washington<br />
Kier Calvin 000000001073 Katsur <strong>Dental</strong> & Orthodontics 661 McKean Avenue Donora PA 15033 General Provider Washington<br />
* Indicates dentist that is accepting current patients only.<br />
All <strong>Select</strong> <strong>Plan</strong> <strong>Dentist</strong>s 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 <strong>Dentist</strong>. Fac ID is used to indicate which facility a member chooses.
SELECT PLAN 1 DENTIST DIRECTORY<br />
<strong>Dentist</strong>s listed are under contract as of 9/1/12<br />
Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />
King David Katsur <strong>Dental</strong> & Orthodontics 661 McKean Avenue Donora PA 15033 Orthodontist Washington<br />
Kolla Siva 000000001073 Katsur <strong>Dental</strong> & Orthodontics 661 McKean Avenue Donora PA 15033 General Provider Washington<br />
Lewis Howell Katsur <strong>Dental</strong> & Orthodontics 661 McKean Avenue Donora PA 15033 Orthodontist Washington<br />
Miller Van Katsur <strong>Dental</strong> & Orthodontics 661 McKean Avenue Donora PA 15033 Orthodontist Washington<br />
Pryor Leroy 000000001073 Katsur <strong>Dental</strong> & Orthodontics 661 McKean Avenue Donora PA 15033 General Provider Washington<br />
Rinchuse Dara Katsur <strong>Dental</strong> & Orthodontics 661 McKean Avenue Donora PA 15033 Orthodontist Washington<br />
Schmidt Alan 000000001073 Katsur <strong>Dental</strong> & Orthodontics 661 McKean Avenue Donora PA 15033 General Provider Washington<br />
Smiga Ingrid 000000001073 Katsur <strong>Dental</strong> & Orthodontics 661 McKean Avenue Donora PA 15033 General Provider Washington<br />
Stein Mark 000000001073 Katsur <strong>Dental</strong> & Orthodontics 661 McKean Avenue Donora PA 15033 General Provider Washington<br />
Tinnemeyer Anjuli 000000001073 Katsur <strong>Dental</strong> & Orthodontics 661 McKean Avenue Donora PA 15033 General Provider Washington<br />
Zalakar Frank 000000001073 Katsur <strong>Dental</strong> & Orthodontics 661 McKean Avenue Donora PA 15033 General Provider Washington<br />
Dandashi Moutaz Katsur <strong>Dental</strong> & Orthodontics Specialists 661 McKean Ave Donora PA 15033 Pedodontist Washington<br />
Hertzler L Gregory Katsur <strong>Dental</strong> & Orthodontics Specialists 661 McKean Ave Donora PA 15033 Oral Surgeon Washington<br />
Kelly Derek Katsur <strong>Dental</strong> & Orthodontics Specialists 661 McKean Ave Donora PA 15033 Oral Surgeon Washington<br />
Kier Gregory Katsur <strong>Dental</strong> & Orthodontics Specialists 661 McKean Ave Donora PA 15033 Periodontist Washington<br />
Monti Richard Katsur <strong>Dental</strong> & Orthodontics Specialists 661 McKean Ave Donora PA 15033 Oral Surgeon Washington<br />
Manalo Arsenio 000000001491 McMurray <strong>Dental</strong> 4143 Washington Road, Waterdam Centre McMurray PA 15317 General Provider Washington<br />
Pruce Robert 000000001442 Robert L. Pruce, D.M.D. 608 East McMurray Road McMurray PA 15317 General Provider Washington<br />
* Roth Gilbert 000000001632 Waterdam <strong>Dental</strong> Associates, P.C. 161 Waterdam Rd., Suite 250 McMurray PA 15317 General Provider Washington<br />
Roth Gilbert 000000001633 Waterdam <strong>Dental</strong> Associates, P.C. 2 Mill Street Millsboro PA 15348 General Provider Washington<br />
Rodriguez Randall 000000001606 Randall Rodriguez, D.M.D. 173 W Main St Monongahela PA 15063 General Provider Washington<br />
Adams William 000000000984 Katsur <strong>Dental</strong> & Orthodontics Rte. 19, North Gate Plaze Washington PA 15301 General Provider Washington<br />
Affolter John 000000000984 Katsur <strong>Dental</strong> & Orthodontics Rte. 19, North Gate Plaze Washington PA 15301 General Provider Washington<br />
Alagirisamy Kiruthika 000000000984 Katsur <strong>Dental</strong> & Orthodontics Rte. 19, North Gate Plaze Washington PA 15301 General Provider Washington<br />
Carozza Roselyn 000000000984 Katsur <strong>Dental</strong> & Orthodontics Rte. 19, North Gate Plaze Washington PA 15301 General Provider Washington<br />
Cohen Ira 000000000984 Katsur <strong>Dental</strong> & Orthodontics Rte. 19, North Gate Plaze Washington PA 15301 General Provider Washington<br />
Dahar Nicholas Katsur <strong>Dental</strong> & Orthodontics Rte. 19, North Gate Plaze Washington PA 15301 Orthodontist Washington<br />
Damich Louis 000000000984 Katsur <strong>Dental</strong> & Orthodontics Rte. 19, North Gate Plaze Washington PA 15301 General Provider Washington<br />
Ghaffari Catherine 000000000984 Katsur <strong>Dental</strong> & Orthodontics Rte. 19, North Gate Plaze Washington PA 15301 General Provider Washington<br />
Ghajarnia M. Reza Katsur <strong>Dental</strong> & Orthodontics Rte. 19, North Gate Plaze Washington PA 15301 Orthodontist Washington<br />
Gillen Steve 000000000984 Katsur <strong>Dental</strong> & Orthodontics Rte. 19, North Gate Plaze Washington PA 15301 General Provider Washington<br />
Iszkula Steven Katsur <strong>Dental</strong> & Orthodontics Rte. 19, North Gate Plaze Washington PA 15301 Orthodontist Washington<br />
Katsur James 000000000984 Katsur <strong>Dental</strong> & Orthodontics Rte. 19, North Gate Plaze Washington PA 15301 General Provider Washington<br />
Khurana Leena 000000000984 Katsur <strong>Dental</strong> & Orthodontics Rte. 19, North Gate Plaze Washington PA 15301 General Provider Washington<br />
Kier Calvin 000000000984 Katsur <strong>Dental</strong> & Orthodontics Rte. 19, North Gate Plaze Washington PA 15301 General Provider Washington<br />
King David Katsur <strong>Dental</strong> & Orthodontics Rte. 19, North Gate Plaze Washington PA 15301 Orthodontist Washington<br />
Kolla Siva 000000000984 Katsur <strong>Dental</strong> & Orthodontics Rte. 19, North Gate Plaze Washington PA 15301 General Provider Washington<br />
Lewis Howell Katsur <strong>Dental</strong> & Orthodontics Rte. 19, North Gate Plaze Washington PA 15301 Orthodontist Washington<br />
Miller Van Katsur <strong>Dental</strong> & Orthodontics Rte. 19, North Gate Plaze Washington PA 15301 Orthodontist Washington<br />
Pryor Leroy 000000000984 Katsur <strong>Dental</strong> & Orthodontics Rte. 19, North Gate Plaze Washington PA 15301 General Provider Washington<br />
Rinchuse Dara Katsur <strong>Dental</strong> & Orthodontics Rte. 19, North Gate Plaze Washington PA 15301 Orthodontist Washington<br />
Schmidt Alan 000000000984 Katsur <strong>Dental</strong> & Orthodontics Rte. 19, North Gate Plaze Washington PA 15301 General Provider Washington<br />
Smiga Ingrid 000000000984 Katsur <strong>Dental</strong> & Orthodontics Rte. 19, North Gate Plaze Washington PA 15301 General Provider Washington<br />
Stein Mark 000000000984 Katsur <strong>Dental</strong> & Orthodontics Rte. 19, North Gate Plaze Washington PA 15301 General Provider Washington<br />
Zalakar Frank 000000000984 Katsur <strong>Dental</strong> & Orthodontics Rte. 19, North Gate Plaze Washington PA 15301 General Provider Washington<br />
Dandashi Moutaz Katsur <strong>Dental</strong> & Orthodontics Specialists Northgate Plaza, Route 19 Washington PA 15301 Pedodontist Washington<br />
Hertzler L Gregory Katsur <strong>Dental</strong> & Orthodontics Specialists Northgate Plaza, Route 19 Washington PA 15301 Oral Surgeon Washington<br />
Kelly Derek Katsur <strong>Dental</strong> & Orthodontics Specialists Northgate Plaza, Route 19 Washington PA 15301 Oral Surgeon Washington<br />
Kier Gregory Katsur <strong>Dental</strong> & Orthodontics Specialists Northgate Plaza, Route 19 Washington PA 15301 Periodontist Washington<br />
Monti Richard Katsur <strong>Dental</strong> & Orthodontics Specialists Northgate Plaza, Route 19 Washington PA 15301 Oral Surgeon Washington<br />
Lucyk-Pavasko Lauren 000000001607 David H.J. Pavasko, D.M.D. 4810 Old William Penn Highway, Suite 4 Export PA 15632 General Provider Westmoreland<br />
Pavasko David 000000001607 David H.J. Pavasko, D.M.D. 4810 Old William Penn Highway, Suite 4 Export PA 15632 General Provider Westmoreland<br />
Nista Mark 000000068481 Nista Family <strong>Dental</strong> Center PC 105 Pfeffer Rd, Suite 2 Export PA 15632 General Provider Westmoreland<br />
Check Jennifer 000000040243 Aspen <strong>Dental</strong> 6088 Route 30 Greensburg PA 15601 General Provider Westmoreland<br />
Ciarallo Robert Aspen <strong>Dental</strong> 6088 Route 30 Greensburg PA 15601 Oral Surgeon Westmoreland<br />
Cignetti Scott 000000040243 Aspen <strong>Dental</strong> 6088 Route 30 Greensburg PA 15601 General Provider Westmoreland<br />
Fazio John 000000040243 Aspen <strong>Dental</strong> 6088 Route 30 Greensburg PA 15601 General Provider Westmoreland<br />
Ferguson III William 000000040243 Aspen <strong>Dental</strong> 6088 Route 30 Greensburg PA 15601 General Provider Westmoreland<br />
Grinberg Anna 000000040243 Aspen <strong>Dental</strong> 6088 Route 30 Greensburg PA 15601 General Provider Westmoreland<br />
Khalil Mirette 000000040243 Aspen <strong>Dental</strong> 6088 Route 30 Greensburg PA 15601 General Provider Westmoreland<br />
Malone Matthew 000000040243 Aspen <strong>Dental</strong> 6088 Route 30 Greensburg PA 15601 General Provider Westmoreland<br />
McCann Eve 000000040243 Aspen <strong>Dental</strong> 6088 Route 30 Greensburg PA 15601 General Provider Westmoreland<br />
McClain Kelly 000000040243 Aspen <strong>Dental</strong> 6088 Route 30 Greensburg PA 15601 General Provider Westmoreland<br />
Monios George 000000040243 Aspen <strong>Dental</strong> 6088 Route 30 Greensburg PA 15601 General Provider Westmoreland<br />
Raja Nabila 000000040243 Aspen <strong>Dental</strong> 6088 Route 30 Greensburg PA 15601 General Provider Westmoreland<br />
Somers Mitchell 000000040243 Aspen <strong>Dental</strong> 6088 Route 30 Greensburg PA 15601 General Provider Westmoreland<br />
* Indicates dentist that is accepting current patients only.<br />
All <strong>Select</strong> <strong>Plan</strong> <strong>Dentist</strong>s Page 38<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 <strong>Dentist</strong>. Fac ID is used to indicate which facility a member chooses.
SELECT PLAN 1 DENTIST DIRECTORY<br />
<strong>Dentist</strong>s listed are under contract as of 9/1/12<br />
Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />
Tam Dominic 000000040243 Aspen <strong>Dental</strong> 6088 Route 30 Greensburg PA 15601 General Provider Westmoreland<br />
Matthews Bruce Bruce A. Matthews, D.M.D., M.D.S. 1225 S. Main Street, Wellington Square, #300 Greensburg PA 15601 Orthodontist Westmoreland<br />
* Kraisinger Paul 000000001667 Complete Family <strong>Dentist</strong>ry 80 Huff Avenue, #1 Greensburg PA 15601 General Provider Westmoreland<br />
Haggard Kai Ying 000000002834 Dent-Al Smiles 29 N. Main St, Suite 206 Greensburg PA 15601 General Provider Westmoreland<br />
Adams William 000000002227 Katsur <strong>Dental</strong> & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 General Provider Westmoreland<br />
Affolter John 000000002227 Katsur <strong>Dental</strong> & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 General Provider Westmoreland<br />
Alagirisamy Kiruthika 000000002227 Katsur <strong>Dental</strong> & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 General Provider Westmoreland<br />
Carozza Roselyn 000000002227 Katsur <strong>Dental</strong> & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 General Provider Westmoreland<br />
Cohen Ira 000000002227 Katsur <strong>Dental</strong> & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 General Provider Westmoreland<br />
Dahar Nicholas Katsur <strong>Dental</strong> & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 Orthodontist Westmoreland<br />
Damich Louis 000000002227 Katsur <strong>Dental</strong> & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 General Provider Westmoreland<br />
Ghaffari Catherine 000000002227 Katsur <strong>Dental</strong> & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 General Provider Westmoreland<br />
Ghajarnia M. Reza Katsur <strong>Dental</strong> & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 Orthodontist Westmoreland<br />
Gillen Steve 000000002227 Katsur <strong>Dental</strong> & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 General Provider Westmoreland<br />
Iszkula Steven Katsur <strong>Dental</strong> & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 Orthodontist Westmoreland<br />
Katsur James 000000002227 Katsur <strong>Dental</strong> & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 General Provider Westmoreland<br />
Khurana Leena 000000002227 Katsur <strong>Dental</strong> & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 General Provider Westmoreland<br />
Kier Calvin 000000002227 Katsur <strong>Dental</strong> & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 General Provider Westmoreland<br />
King David Katsur <strong>Dental</strong> & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 Orthodontist Westmoreland<br />
Kolla Siva 000000002227 Katsur <strong>Dental</strong> & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 General Provider Westmoreland<br />
Lewis Howell Katsur <strong>Dental</strong> & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 Orthodontist Westmoreland<br />
Miller Van Katsur <strong>Dental</strong> & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 Orthodontist Westmoreland<br />
Pryor Leroy 000000002227 Katsur <strong>Dental</strong> & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 General Provider Westmoreland<br />
Rinchuse Dara Katsur <strong>Dental</strong> & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 Orthodontist Westmoreland<br />
Schmidt Alan 000000002227 Katsur <strong>Dental</strong> & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 General Provider Westmoreland<br />
Smiga Ingrid 000000002227 Katsur <strong>Dental</strong> & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 General Provider Westmoreland<br />
Stein Mark 000000002227 Katsur <strong>Dental</strong> & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 General Provider Westmoreland<br />
Tinnemeyer Anjuli 000000002227 Katsur <strong>Dental</strong> & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 General Provider Westmoreland<br />
Zalakar Frank 000000002227 Katsur <strong>Dental</strong> & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 General Provider Westmoreland<br />
Dandashi Moutaz Katsur <strong>Dental</strong> & Orthodontics Specialists 801 Greengate Rd, Suite 310 Greensburg PA 15601 Pedodontist Westmoreland<br />
Hertzler L Gregory Katsur <strong>Dental</strong> & Orthodontics Specialists 801 Greengate Rd, Suite 310 Greensburg PA 15601 Oral Surgeon Westmoreland<br />
Kelly Derek Katsur <strong>Dental</strong> & Orthodontics Specialists 801 Greengate Rd, Suite 310 Greensburg PA 15601 Oral Surgeon Westmoreland<br />
Kier Gregory Katsur <strong>Dental</strong> & Orthodontics Specialists 801 Greengate Rd, Suite 310 Greensburg PA 15601 Periodontist Westmoreland<br />
Monti Richard Katsur <strong>Dental</strong> & Orthodontics Specialists 801 Greengate Rd, Suite 310 Greensburg PA 15601 Oral Surgeon Westmoreland<br />
Vince Thomas 000000001536 Thomas S. Vince, D.M.D. & Associates 985 Towne Square Drive, Suite 100 Greensburg PA 15601 General Provider Westmoreland<br />
Purvis Kenneth Kenneth G. Purvis D.D.S. Ltd. 1010 Jefferson Street Latrobe PA 15650 Orthodontist Westmoreland<br />
Matthews Bruce Bruce A. Matthews, D.M.D., M.D.S. 123 W. Main Street, Suite 1 Ligonier PA 15658 Orthodontist Westmoreland<br />
Purvis Kenneth Kenneth G. Purvis, D.D.S. Ltd. 112 South Walnut Ligonier PA 15658 Orthodontist Westmoreland<br />
Adams William 000000000989 Katsur <strong>Dental</strong> & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 General Provider Westmoreland<br />
Affolter John 000000000989 Katsur <strong>Dental</strong> & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 General Provider Westmoreland<br />
Alagirisamy Kiruthika 000000000989 Katsur <strong>Dental</strong> & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 General Provider Westmoreland<br />
Carozza Roselyn 000000000989 Katsur <strong>Dental</strong> & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 General Provider Westmoreland<br />
Cohen Ira 000000000989 Katsur <strong>Dental</strong> & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 General Provider Westmoreland<br />
Dahar Nicholas Katsur <strong>Dental</strong> & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 Orthodontist Westmoreland<br />
Damich Louis 000000000989 Katsur <strong>Dental</strong> & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 General Provider Westmoreland<br />
Ghaffari Catherine 000000000989 Katsur <strong>Dental</strong> & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 General Provider Westmoreland<br />
Ghajarnia M. Reza Katsur <strong>Dental</strong> & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 Orthodontist Westmoreland<br />
Gillen Steve 000000000989 Katsur <strong>Dental</strong> & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 General Provider Westmoreland<br />
Iszkula Steven Katsur <strong>Dental</strong> & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 Orthodontist Westmoreland<br />
Katsur James 000000000989 Katsur <strong>Dental</strong> & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 General Provider Westmoreland<br />
Khurana Leena 000000000989 Katsur <strong>Dental</strong> & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 General Provider Westmoreland<br />
Kier Calvin 000000000989 Katsur <strong>Dental</strong> & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 General Provider Westmoreland<br />
King David Katsur <strong>Dental</strong> & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 Orthodontist Westmoreland<br />
Kolla Siva 000000000989 Katsur <strong>Dental</strong> & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 General Provider Westmoreland<br />
Lewis Howell Katsur <strong>Dental</strong> & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 Orthodontist Westmoreland<br />
Miller Van Katsur <strong>Dental</strong> & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 Orthodontist Westmoreland<br />
Pryor Leroy 000000000989 Katsur <strong>Dental</strong> & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 General Provider Westmoreland<br />
Rinchuse Dara Katsur <strong>Dental</strong> & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 Orthodontist Westmoreland<br />
Schmidt Alan 000000000989 Katsur <strong>Dental</strong> & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 General Provider Westmoreland<br />
Smiga Ingrid 000000000989 Katsur <strong>Dental</strong> & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 General Provider Westmoreland<br />
Stein Mark 000000000989 Katsur <strong>Dental</strong> & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 General Provider Westmoreland<br />
Tinnemeyer Anjuli 000000000989 Katsur <strong>Dental</strong> & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 General Provider Westmoreland<br />
Zalakar Frank 000000000989 Katsur <strong>Dental</strong> & Orthodontics 129 Hillcrest Shopping Ctr Lower Burrell PA 15068 General Provider Westmoreland<br />
Dandashi Moutaz Katsur <strong>Dental</strong> & Orthodontics Specialists 129 Hillcrest Shopping Center Lower Burrell PA 15068 Pedodontist Westmoreland<br />
Hertzler L Gregory Katsur <strong>Dental</strong> & Orthodontics Specialists 129 Hillcrest Shopping Center Lower Burrell PA 15068 Oral Surgeon Westmoreland<br />
Kelly Derek Katsur <strong>Dental</strong> & Orthodontics Specialists 129 Hillcrest Shopping Center Lower Burrell PA 15068 Oral Surgeon Westmoreland<br />
* Indicates dentist that is accepting current patients only.<br />
All <strong>Select</strong> <strong>Plan</strong> <strong>Dentist</strong>s 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 <strong>Dentist</strong>. Fac ID is used to indicate which facility a member chooses.
SELECT PLAN 1 DENTIST DIRECTORY<br />
<strong>Dentist</strong>s listed are under contract as of 9/1/12<br />
Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />
Kier Gregory Katsur <strong>Dental</strong> & Orthodontics Specialists 129 Hillcrest Shopping Center Lower Burrell PA 15068 Periodontist Westmoreland<br />
Monti Richard Katsur <strong>Dental</strong> & Orthodontics Specialists 129 Hillcrest Shopping Center Lower Burrell PA 15068 Oral Surgeon Westmoreland<br />
Kreashko Robert Kreashko Orthodontics 2755 Leechburg Rd. Lower Burrell PA 15068 Orthodontist Westmoreland<br />
Seitz Raymond 000000002330 Raymond C. Seitz, D.M.D. 2797 Leechburg Road Lower Burrell PA 15068 General Provider Westmoreland<br />
Al Rasheed Manuela 000000001898 Manuela Al Rasheed, D.M.D. 828 W. Main Street Mount Pleasant PA 15666 General Provider Westmoreland<br />
Santora Donald 000000001608 Mt Pleasant <strong>Dental</strong> Associates PC 770 Route 819 South, P.O. Box 954 Mount Pleasant PA 15666 General Provider Westmoreland<br />
Loyacona Gerald Gerald Loyacona, D.M.D. 4771 Old William Penn Hwy. Murrysville PA 15668 Orthodontist Westmoreland<br />
Balasubramaniam Ravi 000000001492 Laurel Highlands Family <strong>Dentist</strong>ry 4057 Old William Penn Murrysville PA 15668 General Provider Westmoreland<br />
Matthews Bruce Bruce A. Matthews, D.M.D., M.D.S. 1061 Main Street, Banco Bus Park, Suite 2CI North Huntingdon PA 15642 Orthodontist Westmoreland<br />
Babameto Blendi Aspen <strong>Dental</strong> 409 Eisenhower Dr Hanover PA 17331 Oral Surgeon York<br />
Desai Jagruti 000000051062 Aspen <strong>Dental</strong> 409 Eisenhower Dr Hanover PA 17331 General Provider York<br />
Kaur Kamaljit 000000051062 Aspen <strong>Dental</strong> 409 Eisenhower Dr Hanover PA 17331 General Provider York<br />
Kuleva Juliana 000000051062 Aspen <strong>Dental</strong> 409 Eisenhower Dr Hanover PA 17331 General Provider York<br />
Popernack John 000000051062 Aspen <strong>Dental</strong> 409 Eisenhower Dr Hanover PA 17331 General Provider York<br />
Talati Ankit 000000051062 Aspen <strong>Dental</strong> 409 Eisenhower Dr Hanover PA 17331 General Provider York<br />
Withanachchi Janatha Aspen <strong>Dental</strong> 409 Eisenhower Dr Hanover PA 17331 Endodontist York<br />
Babameto Blendi Aspen <strong>Dental</strong> Associates of NE PA PC 2803 Concord Rd York PA 17402 Oral Surgeon York<br />
Botros Samuel 000000037962 Aspen <strong>Dental</strong> Associates of NE PA PC 2803 Concord Rd York PA 17402 General Provider York<br />
Chandalada Agastayya 000000037962 Aspen <strong>Dental</strong> Associates of NE PA PC 2803 Concord Rd York PA 17402 General Provider York<br />
Hu Yu Hui 000000037962 Aspen <strong>Dental</strong> Associates of NE PA PC 2803 Concord Rd York PA 17402 General Provider York<br />
Mercado Conchita 000000037962 Aspen <strong>Dental</strong> Associates of NE PA PC 2803 Concord Rd York PA 17402 General Provider York<br />
Pham Thuy 000000037962 Aspen <strong>Dental</strong> Associates of NE PA PC 2803 Concord Rd York PA 17402 General Provider York<br />
Tran Joshua 000000037962 Aspen <strong>Dental</strong> Associates of NE PA PC 2803 Concord Rd York PA 17402 General Provider York<br />
Williams Christopher 000000037962 Aspen <strong>Dental</strong> Associates of NE PA PC 2803 Concord Rd York PA 17402 General Provider York<br />
Withanachchi Janatha Aspen <strong>Dental</strong> Associates of NE PA PC 2803 Concord Rd York PA 17402 Endodontist York<br />
Babameto Blendi Aspen <strong>Dental</strong> Associates of NE PA PC 1101 Carlisle Rd. York PA 17404 Oral Surgeon York<br />
Botros Samuel 000000033834 Aspen <strong>Dental</strong> Associates of NE PA PC 1101 Carlisle Rd. York PA 17404 General Provider York<br />
Chandalada Agastayya 000000033834 Aspen <strong>Dental</strong> Associates of NE PA PC 1101 Carlisle Rd. York PA 17404 General Provider York<br />
Chaudhry Ahmad 000000033834 Aspen <strong>Dental</strong> Associates of NE PA PC 1101 Carlisle Rd. York PA 17404 General Provider York<br />
Hamati Isam 000000033834 Aspen <strong>Dental</strong> Associates of NE PA PC 1101 Carlisle Rd. York PA 17404 General Provider York<br />
Hu Yu Hui 000000033834 Aspen <strong>Dental</strong> Associates of NE PA PC 1101 Carlisle Rd. York PA 17404 General Provider York<br />
Mercado Conchita 000000033834 Aspen <strong>Dental</strong> Associates of NE PA PC 1101 Carlisle Rd. York PA 17404 General Provider York<br />
Pham Thuy 000000033834 Aspen <strong>Dental</strong> Associates of NE PA PC 1101 Carlisle Rd. York PA 17404 General Provider York<br />
Tran Joshua 000000033834 Aspen <strong>Dental</strong> Associates of NE PA PC 1101 Carlisle Rd. York PA 17404 General Provider York<br />
Williams Christopher 000000033834 Aspen <strong>Dental</strong> Associates of NE PA PC 1101 Carlisle Rd. York PA 17404 General Provider York<br />
Withanachchi Janatha Aspen <strong>Dental</strong> Associates of NE PA PC 1101 Carlisle Rd. York PA 17404 Endodontist York<br />
Byrnside Valerie Scott R Goodove DDS PLC 25529 E Main St Onley VA 23418 Oral Surgeon Accomack<br />
Goodove Scott Scott R Goodove DDS PLC 25529 E Main St Onley VA 23418 Oral Surgeon Accomack<br />
Harris Christopher Scott R Goodove DDS PLC 25529 E Main St Onley VA 23418 Oral Surgeon Accomack<br />
Kotler Lawrence Lawrence M. Kotler, D.D.S., MS. 3543 W. Braddock Rd., E-1 Alexandria VA 22302 Endodontist Alexandria City<br />
Phan Phuong 000000002274 Phuong Phan D.MD PC 1225 Martha Custis Drive, #C-6 Alexandria VA 22302 General Provider Alexandria City<br />
Alayssami Mazin 000000000144 Bright Now <strong>Dental</strong> 5249 Duke Street, Suite 210 Alexandria VA 22304 General Provider Alexandria City<br />
Khattak Farida 000000000144 Bright Now <strong>Dental</strong> 5249 Duke Street, Suite 210 Alexandria VA 22304 General Provider Alexandria City<br />
Selenou-Tema Alain 000000000144 Bright Now <strong>Dental</strong> 5249 Duke Street, Suite 210 Alexandria VA 22304 General Provider Alexandria City<br />
Meza Fernando Fernando J. Meza, DMD, PLLC 4660 Kenmore Ave, 700 Alexandria VA 22304 Endodontist Alexandria City<br />
Russo Revand Jessica Fernando J. Meza, DMD, PLLC 4660 Kenmore Ave, 700 Alexandria VA 22304 Endodontist Alexandria City<br />
Tsui Nathan 000000000239 Nathan Tsui, D.D.S. 5249 Duke St., Suite 10 Alexandria VA 22304 General Provider Alexandria City<br />
Kwon Thomas 000000000342 Thomas S. Kwon, D.D.S. 4701 Kenmore Ave., Suite 122 Alexandria VA 22304 General Provider Alexandria City<br />
Tolson Ronald 000000000215 Ronald E Tolson DDS 5246 Dawes Ave Alexandria VA 22311 General Provider Alexandria City<br />
Kermanshi Shiva Alexandria <strong>Dental</strong> Care PLLC 715 Pendleton St Alexandria VA 22314 Orthodontist Alexandria City<br />
Solemaninejad Homan 000000050340 Alexandria <strong>Dental</strong> Care PLLC 715 Pendleton St Alexandria VA 22314 General Provider Alexandria City<br />
Gasper Ronald Ronald S. Gasper, D.D.S., Ltd. 1454 Duke St, Suite 200 Alexandria VA 22314 Orthodontist Alexandria City<br />
Huynh Thuylinh Arlington Center For <strong>Dentist</strong>ry Orthodontics 1050 N Highland St, 300-N Arlington VA 22201 Orthodontist Arlington<br />
Asher Kevin Arlington Center for <strong>Dentist</strong>ry Specialists 1050 N Highland St, 300-N Arlington VA 22201 Oral Surgeon Arlington<br />
Colosi Ryan Arlington Center for <strong>Dentist</strong>ry Specialists 1050 N Highland St, 300-N Arlington VA 22201 Pedodontist Arlington<br />
Gichana Roselyne Arlington Center for <strong>Dentist</strong>ry Specialists 1050 N Highland St, 300-N Arlington VA 22201 Pedodontist Arlington<br />
Lan Steve Arlington Center for <strong>Dentist</strong>ry Specialists 1050 N Highland St, 300-N Arlington VA 22201 Pedodontist Arlington<br />
Nguyen Phuong Arlington Center for <strong>Dentist</strong>ry Specialists 1050 N Highland St, 300-N Arlington VA 22201 Oral Surgeon Arlington<br />
Park Nam Arlington Center for <strong>Dentist</strong>ry Specialists 1050 N Highland St, 300-N Arlington VA 22201 Oral Surgeon Arlington<br />
Shambayati Sara Arlington Center for <strong>Dentist</strong>ry Specialists 1050 N Highland St, 300-N Arlington VA 22201 Endodontist Arlington<br />
Son Joseph Arlington Center for <strong>Dentist</strong>ry Specialists 1050 N Highland St, 300-N Arlington VA 22201 Endodontist Arlington<br />
Shambayati Sara Mariah Shojaei, D.M.D. 1731 Clarendon Blvd Arlington VA 22201 Endodontist Arlington<br />
Shojaei Mariah Mariah Shojaei, D.M.D. 1731 Clarendon Blvd Arlington VA 22201 Endodontist Arlington<br />
* Economides Mino 000000000939 Mino Economides, D.D.S. 1301 N. Highland Street Arlington VA 22201 General Provider Arlington<br />
* Lebo Carl 000000000233 Carl G Lebo DDS PC 3801 N. Fairfax Dr., Suite 72 Arlington VA 22203 General Provider Arlington<br />
Zadeh David 000000001664 Zadeh <strong>Dental</strong> Office 611 S. Carlin Springs Road, Suite 408 Arlington VA 22204 General Provider Arlington<br />
* Indicates dentist that is accepting current patients only.<br />
All <strong>Select</strong> <strong>Plan</strong> <strong>Dentist</strong>s Page 40<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 <strong>Dentist</strong>. Fac ID is used to indicate which facility a member chooses.
SELECT PLAN 1 DENTIST DIRECTORY<br />
<strong>Dentist</strong>s listed are under contract as of 9/1/12<br />
Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />
Patterson Travis Drs. Whiston, Patterson & Corcoran 2501 N. Glebe Road, Suite 203 Arlington VA 22207 Oral Surgeon Arlington<br />
Saleh Fadi Fadi Saleh DDS LLC 1911 N Fort Myer Drive, Suite 101 Arlington VA 22209 Orthodontist Arlington<br />
Mogharbel Tarek 000000037711 Mira <strong>Dental</strong> Care 1901 N Moore St, Suite 501 Arlington VA 22209 General Provider Arlington<br />
Boyce Darrell 000000002606 Darrell L. Boyce, D.D.S.,P.C. 1711 Parkview Dr. Chesapeake VA 23320 General Provider Chesapeake City<br />
* Abdelwahab Tamer 000000068512 Konikoff <strong>Dental</strong> Associates 1533 Volvo Pkwy Chesapeake VA 23320 General Provider Chesapeake City<br />
* Abdelwahab Tamer 000000050722 Konikoff <strong>Dental</strong> Associates 684 Battlefield Blvd Chesapeake VA 23320 General Provider Chesapeake City<br />
* Ansari Uzma 000000068512 Konikoff <strong>Dental</strong> Associates 1533 Volvo Pkwy Chesapeake VA 23320 General Provider Chesapeake City<br />
* Ansari Uzma 000000050722 Konikoff <strong>Dental</strong> Associates 684 Battlefield Blvd Chesapeake VA 23320 General Provider Chesapeake City<br />
* Berrada Sanae 000000068512 Konikoff <strong>Dental</strong> Associates 1533 Volvo Pkwy Chesapeake VA 23320 General Provider Chesapeake City<br />
* Berrada Sanae 000000050722 Konikoff <strong>Dental</strong> Associates 684 Battlefield Blvd Chesapeake VA 23320 General Provider Chesapeake City<br />
* Bozman Jenny 000000068512 Konikoff <strong>Dental</strong> Associates 1533 Volvo Pkwy Chesapeake VA 23320 General Provider Chesapeake City<br />
* Bozman Jenny 000000050722 Konikoff <strong>Dental</strong> Associates 684 Battlefield Blvd Chesapeake VA 23320 General Provider Chesapeake City<br />
* Chawla Seema 000000068512 Konikoff <strong>Dental</strong> Associates 1533 Volvo Pkwy Chesapeake VA 23320 General Provider Chesapeake City<br />
* Chawla Seema 000000050722 Konikoff <strong>Dental</strong> Associates 684 Battlefield Blvd Chesapeake VA 23320 General Provider Chesapeake City<br />
* Dobson Roberta 000000068512 Konikoff <strong>Dental</strong> Associates 1533 Volvo Pkwy Chesapeake VA 23320 General Provider Chesapeake City<br />
* Dobson Roberta 000000050722 Konikoff <strong>Dental</strong> Associates 684 Battlefield Blvd Chesapeake VA 23320 General Provider Chesapeake City<br />
* Dobson, III Joseph 000000068512 Konikoff <strong>Dental</strong> Associates 1533 Volvo Pkwy Chesapeake VA 23320 General Provider Chesapeake City<br />
* Dobson, III Joseph 000000050722 Konikoff <strong>Dental</strong> Associates 684 Battlefield Blvd Chesapeake VA 23320 General Provider Chesapeake City<br />
* Elosta Wael 000000068512 Konikoff <strong>Dental</strong> Associates 1533 Volvo Pkwy Chesapeake VA 23320 General Provider Chesapeake City<br />
* Elosta Wael 000000050722 Konikoff <strong>Dental</strong> Associates 684 Battlefield Blvd Chesapeake VA 23320 General Provider Chesapeake City<br />
* Field Marcus 000000068512 Konikoff <strong>Dental</strong> Associates 1533 Volvo Pkwy Chesapeake VA 23320 General Provider Chesapeake City<br />
* Field Marcus 000000050722 Konikoff <strong>Dental</strong> Associates 684 Battlefield Blvd Chesapeake VA 23320 General Provider Chesapeake City<br />
* Field Sheila 000000068512 Konikoff <strong>Dental</strong> Associates 1533 Volvo Pkwy Chesapeake VA 23320 General Provider Chesapeake City<br />
* Field Sheila 000000050722 Konikoff <strong>Dental</strong> Associates 684 Battlefield Blvd Chesapeake VA 23320 General Provider Chesapeake City<br />
* Gioffre Mollie 000000068512 Konikoff <strong>Dental</strong> Associates 1533 Volvo Pkwy Chesapeake VA 23320 General Provider Chesapeake City<br />
* Gioffre Mollie 000000050722 Konikoff <strong>Dental</strong> Associates 684 Battlefield Blvd Chesapeake VA 23320 General Provider Chesapeake City<br />
* Hoek Meredith 000000068512 Konikoff <strong>Dental</strong> Associates 1533 Volvo Pkwy Chesapeake VA 23320 General Provider Chesapeake City<br />
* Hoek Meredith 000000050722 Konikoff <strong>Dental</strong> Associates 684 Battlefield Blvd Chesapeake VA 23320 General Provider Chesapeake City<br />
* Jones Daniel 000000068512 Konikoff <strong>Dental</strong> Associates 1533 Volvo Pkwy Chesapeake VA 23320 General Provider Chesapeake City<br />
* Jones Daniel 000000050722 Konikoff <strong>Dental</strong> Associates 684 Battlefield Blvd Chesapeake VA 23320 General Provider Chesapeake City<br />
* Konikoff David 000000068512 Konikoff <strong>Dental</strong> Associates 1533 Volvo Pkwy Chesapeake VA 23320 General Provider Chesapeake City<br />
* Konikoff David 000000050722 Konikoff <strong>Dental</strong> Associates 684 Battlefield Blvd Chesapeake VA 23320 General Provider Chesapeake City<br />
* Lanigan Jacqueline 000000068512 Konikoff <strong>Dental</strong> Associates 1533 Volvo Pkwy Chesapeake VA 23320 General Provider Chesapeake City<br />
* Lanigan Jacqueline 000000050722 Konikoff <strong>Dental</strong> Associates 684 Battlefield Blvd Chesapeake VA 23320 General Provider Chesapeake City<br />
* Maclin Ivetta 000000068512 Konikoff <strong>Dental</strong> Associates 1533 Volvo Pkwy Chesapeake VA 23320 General Provider Chesapeake City<br />
* Maclin Ivetta 000000050722 Konikoff <strong>Dental</strong> Associates 684 Battlefield Blvd Chesapeake VA 23320 General Provider Chesapeake City<br />
* Mady Zeyad 000000068512 Konikoff <strong>Dental</strong> Associates 1533 Volvo Pkwy Chesapeake VA 23320 General Provider Chesapeake City<br />
* Mady Zeyad 000000050722 Konikoff <strong>Dental</strong> Associates 684 Battlefield Blvd Chesapeake VA 23320 General Provider Chesapeake City<br />
* Maniwang Jo-Marie 000000068512 Konikoff <strong>Dental</strong> Associates 1533 Volvo Pkwy Chesapeake VA 23320 General Provider Chesapeake City<br />
* Maniwang Jo-Marie 000000050722 Konikoff <strong>Dental</strong> Associates 684 Battlefield Blvd Chesapeake VA 23320 General Provider Chesapeake City<br />
* Mattioli Michele 000000068512 Konikoff <strong>Dental</strong> Associates 1533 Volvo Pkwy Chesapeake VA 23320 General Provider Chesapeake City<br />
* Mattioli Michele 000000050722 Konikoff <strong>Dental</strong> Associates 684 Battlefield Blvd Chesapeake VA 23320 General Provider Chesapeake City<br />
* McCarty Benjamin 000000068512 Konikoff <strong>Dental</strong> Associates 1533 Volvo Pkwy Chesapeake VA 23320 General Provider Chesapeake City<br />
* McCarty Benjamin 000000050722 Konikoff <strong>Dental</strong> Associates 684 Battlefield Blvd Chesapeake VA 23320 General Provider Chesapeake City<br />
* Miranda Joshua 000000068512 Konikoff <strong>Dental</strong> Associates 1533 Volvo Pkwy Chesapeake VA 23320 General Provider Chesapeake City<br />
* Miranda Joshua 000000050722 Konikoff <strong>Dental</strong> Associates 684 Battlefield Blvd Chesapeake VA 23320 General Provider Chesapeake City<br />
* Morris Mason-Leigh 000000068512 Konikoff <strong>Dental</strong> Associates 1533 Volvo Pkwy Chesapeake VA 23320 General Provider Chesapeake City<br />
* Morris Mason-Leigh 000000050722 Konikoff <strong>Dental</strong> Associates 684 Battlefield Blvd Chesapeake VA 23320 General Provider Chesapeake City<br />
* Muldoon Catherine 000000068512 Konikoff <strong>Dental</strong> Associates 1533 Volvo Pkwy Chesapeake VA 23320 General Provider Chesapeake City<br />
* Muldoon Catherine 000000050722 Konikoff <strong>Dental</strong> Associates 684 Battlefield Blvd Chesapeake VA 23320 General Provider Chesapeake City<br />
* Parker Richard 000000068512 Konikoff <strong>Dental</strong> Associates 1533 Volvo Pkwy Chesapeake VA 23320 General Provider Chesapeake City<br />
* Parker Richard 000000050722 Konikoff <strong>Dental</strong> Associates 684 Battlefield Blvd Chesapeake VA 23320 General Provider Chesapeake City<br />
* Pearl Dina 000000068512 Konikoff <strong>Dental</strong> Associates 1533 Volvo Pkwy Chesapeake VA 23320 General Provider Chesapeake City<br />
* Pearl Dina 000000050722 Konikoff <strong>Dental</strong> Associates 684 Battlefield Blvd Chesapeake VA 23320 General Provider Chesapeake City<br />
* Reichley John 000000068512 Konikoff <strong>Dental</strong> Associates 1533 Volvo Pkwy Chesapeake VA 23320 General Provider Chesapeake City<br />
* Reichley John 000000050722 Konikoff <strong>Dental</strong> Associates 684 Battlefield Blvd Chesapeake VA 23320 General Provider Chesapeake City<br />
* Richards Damdy 000000068512 Konikoff <strong>Dental</strong> Associates 1533 Volvo Pkwy Chesapeake VA 23320 General Provider Chesapeake City<br />
* Richards Damdy 000000050722 Konikoff <strong>Dental</strong> Associates 684 Battlefield Blvd Chesapeake VA 23320 General Provider Chesapeake City<br />
* Santos Estelito 000000068512 Konikoff <strong>Dental</strong> Associates 1533 Volvo Pkwy Chesapeake VA 23320 General Provider Chesapeake City<br />
* Santos Estelito 000000050722 Konikoff <strong>Dental</strong> Associates 684 Battlefield Blvd Chesapeake VA 23320 General Provider Chesapeake City<br />
* Solarte-Castro Edith 000000068512 Konikoff <strong>Dental</strong> Associates 1533 Volvo Pkwy Chesapeake VA 23320 General Provider Chesapeake City<br />
* Solarte-Castro Edith 000000050722 Konikoff <strong>Dental</strong> Associates 684 Battlefield Blvd Chesapeake VA 23320 General Provider Chesapeake City<br />
* Tam Amy 000000068512 Konikoff <strong>Dental</strong> Associates 1533 Volvo Pkwy Chesapeake VA 23320 General Provider Chesapeake City<br />
* Tam Amy 000000050722 Konikoff <strong>Dental</strong> Associates 684 Battlefield Blvd Chesapeake VA 23320 General Provider Chesapeake City<br />
* Throckmorton Maria 000000068512 Konikoff <strong>Dental</strong> Associates 1533 Volvo Pkwy Chesapeake VA 23320 General Provider Chesapeake City<br />
* Throckmorton Maria 000000050722 Konikoff <strong>Dental</strong> Associates 684 Battlefield Blvd Chesapeake VA 23320 General Provider Chesapeake City<br />
* Indicates dentist that is accepting current patients only.<br />
All <strong>Select</strong> <strong>Plan</strong> <strong>Dentist</strong>s Page 41<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 <strong>Dentist</strong>. Fac ID is used to indicate which facility a member chooses.
SELECT PLAN 1 DENTIST DIRECTORY<br />
<strong>Dentist</strong>s listed are under contract as of 9/1/12<br />
Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />
Reynolds Jillian LWSS <strong>Dentist</strong>ry for Children 1230 Progressive Dr, Suite 103 Chesapeake VA 23320 Pedodontist Chesapeake City<br />
Sachs Scott LWSS <strong>Dentist</strong>ry for Children 1230 Progressive Dr, Suite 103 Chesapeake VA 23320 Pedodontist Chesapeake City<br />
Kaplan Marvin Marvin Kaplan, D.D.S., P.C. 113 Byron St. Chesapeake VA 23320 Orthodontist Chesapeake City<br />
Ashby John Owens and Dorfman, LTD 1021 N. Eden Way, Suite 128 Chesapeake VA 23320 Orthodontist Chesapeake City<br />
Dailey Curtis Owens and Dorfman, LTD 1021 N. Eden Way, Suite 128 Chesapeake VA 23320 Orthodontist Chesapeake City<br />
Quigg Richard Richard K. Quigg, D.D.S. 505 Independence Parkway, Suite 108 Chesapeake VA 23320 Oral Surgeon Chesapeake City<br />
Morrison Sanford S. Neil Morrison, DDS, & Melvin R. Morrison, DDS 1230 Progressive Center, Suite 102 Chesapeake VA 23320 Oral Surgeon Chesapeake City<br />
Byrnside Valerie Scott R Goodove DDS PLC 1533 Volvo Parkway, Suite 250 Chesapeake VA 23320 Oral Surgeon Chesapeake City<br />
Goodove Scott Scott R Goodove DDS PLC 1533 Volvo Parkway, Suite 250 Chesapeake VA 23320 Oral Surgeon Chesapeake City<br />
Harris Christopher Scott R Goodove DDS PLC 1533 Volvo Parkway, Suite 250 Chesapeake VA 23320 Oral Surgeon Chesapeake City<br />
* Abdelwahab Tamer 000000050721 Konikoff <strong>Dental</strong> Associates 1419 Cedar Rd Chesapeake VA 23322 General Provider Chesapeake City<br />
* Ansari Uzma 000000050721 Konikoff <strong>Dental</strong> Associates 1419 Cedar Rd Chesapeake VA 23322 General Provider Chesapeake City<br />
* Berrada Sanae 000000050721 Konikoff <strong>Dental</strong> Associates 1419 Cedar Rd Chesapeake VA 23322 General Provider Chesapeake City<br />
* Bozman Jenny 000000050721 Konikoff <strong>Dental</strong> Associates 1419 Cedar Rd Chesapeake VA 23322 General Provider Chesapeake City<br />
* Chawla Seema 000000050721 Konikoff <strong>Dental</strong> Associates 1419 Cedar Rd Chesapeake VA 23322 General Provider Chesapeake City<br />
* Dobson Roberta 000000050721 Konikoff <strong>Dental</strong> Associates 1419 Cedar Rd Chesapeake VA 23322 General Provider Chesapeake City<br />
* Dobson, III Joseph 000000050721 Konikoff <strong>Dental</strong> Associates 1419 Cedar Rd Chesapeake VA 23322 General Provider Chesapeake City<br />
* Elosta Wael 000000050721 Konikoff <strong>Dental</strong> Associates 1419 Cedar Rd Chesapeake VA 23322 General Provider Chesapeake City<br />
* Field Marcus 000000050721 Konikoff <strong>Dental</strong> Associates 1419 Cedar Rd Chesapeake VA 23322 General Provider Chesapeake City<br />
* Field Sheila 000000050721 Konikoff <strong>Dental</strong> Associates 1419 Cedar Rd Chesapeake VA 23322 General Provider Chesapeake City<br />
* Gioffre Mollie 000000050721 Konikoff <strong>Dental</strong> Associates 1419 Cedar Rd Chesapeake VA 23322 General Provider Chesapeake City<br />
* Hoek Meredith 000000050721 Konikoff <strong>Dental</strong> Associates 1419 Cedar Rd Chesapeake VA 23322 General Provider Chesapeake City<br />
* Jones Daniel 000000050721 Konikoff <strong>Dental</strong> Associates 1419 Cedar Rd Chesapeake VA 23322 General Provider Chesapeake City<br />
* Konikoff David 000000050721 Konikoff <strong>Dental</strong> Associates 1419 Cedar Rd Chesapeake VA 23322 General Provider Chesapeake City<br />
* Lanigan Jacqueline 000000050721 Konikoff <strong>Dental</strong> Associates 1419 Cedar Rd Chesapeake VA 23322 General Provider Chesapeake City<br />
* Maclin Ivetta 000000050721 Konikoff <strong>Dental</strong> Associates 1419 Cedar Rd Chesapeake VA 23322 General Provider Chesapeake City<br />
* Mady Zeyad 000000050721 Konikoff <strong>Dental</strong> Associates 1419 Cedar Rd Chesapeake VA 23322 General Provider Chesapeake City<br />
* Maniwang Jo-Marie 000000050721 Konikoff <strong>Dental</strong> Associates 1419 Cedar Rd Chesapeake VA 23322 General Provider Chesapeake City<br />
* Mattioli Michele 000000050721 Konikoff <strong>Dental</strong> Associates 1419 Cedar Rd Chesapeake VA 23322 General Provider Chesapeake City<br />
* McCarty Benjamin 000000050721 Konikoff <strong>Dental</strong> Associates 1419 Cedar Rd Chesapeake VA 23322 General Provider Chesapeake City<br />
* Miranda Joshua 000000050721 Konikoff <strong>Dental</strong> Associates 1419 Cedar Rd Chesapeake VA 23322 General Provider Chesapeake City<br />
* Morris Mason-Leigh 000000050721 Konikoff <strong>Dental</strong> Associates 1419 Cedar Rd Chesapeake VA 23322 General Provider Chesapeake City<br />
* Muldoon Catherine 000000050721 Konikoff <strong>Dental</strong> Associates 1419 Cedar Rd Chesapeake VA 23322 General Provider Chesapeake City<br />
* Parker Richard 000000050721 Konikoff <strong>Dental</strong> Associates 1419 Cedar Rd Chesapeake VA 23322 General Provider Chesapeake City<br />
* Pearl Dina 000000050721 Konikoff <strong>Dental</strong> Associates 1419 Cedar Rd Chesapeake VA 23322 General Provider Chesapeake City<br />
* Reichley John 000000050721 Konikoff <strong>Dental</strong> Associates 1419 Cedar Rd Chesapeake VA 23322 General Provider Chesapeake City<br />
* Richards Damdy 000000050721 Konikoff <strong>Dental</strong> Associates 1419 Cedar Rd Chesapeake VA 23322 General Provider Chesapeake City<br />
* Santos Estelito 000000050721 Konikoff <strong>Dental</strong> Associates 1419 Cedar Rd Chesapeake VA 23322 General Provider Chesapeake City<br />
* Solarte-Castro Edith 000000050721 Konikoff <strong>Dental</strong> Associates 1419 Cedar Rd Chesapeake VA 23322 General Provider Chesapeake City<br />
* Tam Amy 000000050721 Konikoff <strong>Dental</strong> Associates 1419 Cedar Rd Chesapeake VA 23322 General Provider Chesapeake City<br />
* Throckmorton Maria 000000050721 Konikoff <strong>Dental</strong> Associates 1419 Cedar Rd Chesapeake VA 23322 General Provider Chesapeake City<br />
Cobb Howard 000000000676 Howard P. Cobb, D.D.S. 2605 Moses Grandy Trl., Suite B Chesapeake VA 23323 General Provider Chesapeake City<br />
Howard Robert 000000000021 Robert J. Howard, D.D.S. 308 N. George Wash. Hwy, Suite 2 Chesapeake VA 23323 General Provider Chesapeake City<br />
Barbour Robert 000000000079 Robert K Barbour, DMD, PC 2520 Gilmerton Rd. Chesapeake VA 23323 General Provider Chesapeake City<br />
Tran Anh Chester Orthodontics 11300 Ironbridge Rd, Suite B Chester VA 23831 Orthodontist Chesterfield<br />
Rodrigues Shwetha 000000002817 Shwetha Rodrigues DDS PC 12619 Jefferson Davis Hwy Chester VA 23831 General Provider Chesterfield<br />
Brown Stephen Chesterfield Oral Surgery, <strong>Inc</strong>. 10110 Iron Bridge Rd. Chesterfield VA 23832 Oral Surgeon Chesterfield<br />
Rhea William 000000000100 William H. Rhea, D.D.S. 10108 Krause Rd. #102 Chesterfield VA 23832 General Provider Chesterfield<br />
Kelleher Kevin Kelleher Orthodontics 2412 Colony Crossing Pl Midlothian VA 23112 Orthodontist Chesterfield<br />
Padgett Thomas Richmond Oral & Cosmetic Surgeons 5921 Harbour Lane, Suite 200 Midlothian VA 23112 Oral Surgeon Chesterfield<br />
Wallace James Richmond Oral & Cosmetic Surgeons 5921 Harbour Lane, Suite 200 Midlothian VA 23112 Oral Surgeon Chesterfield<br />
Agnihotri Neil Virginia Oral & Facial Surgery 6031 Harbour Park Dr Midlothian VA 23112 Oral Surgeon Chesterfield<br />
Alexander John Virginia Oral & Facial Surgery 6031 Harbour Park Dr Midlothian VA 23112 Oral Surgeon Chesterfield<br />
Dymon William Virginia Oral & Facial Surgery 6031 Harbour Park Dr Midlothian VA 23112 Oral Surgeon Chesterfield<br />
Harris Monroe Virginia Oral & Facial Surgery 6031 Harbour Park Dr Midlothian VA 23112 Oral Surgeon Chesterfield<br />
Keeney Kanyon Virginia Oral & Facial Surgery 6031 Harbour Park Dr Midlothian VA 23112 Oral Surgeon Chesterfield<br />
Metzger Lawrence Virginia Oral & Facial Surgery 6031 Harbour Park Dr Midlothian VA 23112 Oral Surgeon Chesterfield<br />
Watson Damon Virginia Oral & Facial Surgery 6031 Harbour Park Dr Midlothian VA 23112 Oral Surgeon Chesterfield<br />
Wlodawsky Ross Virginia Oral & Facial Surgery 6031 Harbour Park Dr Midlothian VA 23112 Oral Surgeon Chesterfield<br />
Gray Richard Apex Endodontics 1149 Jefferson Green Cir Midlothian VA 23113 Endodontist Chesterfield<br />
Kim John 000000000005 John J Kim DDS 2927 Polo Parkway Midlothian VA 23113 General Provider Chesterfield<br />
Byrd Richard Richard L. Byrd., D.D.S. 2929 Polo Parkway Midlothian VA 23113 Orthodontist Chesterfield<br />
Padgett Thomas Richmond Oral & Cosmetic Surgeons 1680 Huguenot Rd. Midlothian VA 23113 Oral Surgeon Chesterfield<br />
Wallace James Richmond Oral & Cosmetic Surgeons 1680 Huguenot Rd. Midlothian VA 23113 Oral Surgeon Chesterfield<br />
Agnihotri Neil Virginia Oral & Facial Surgery 11319 Polo Place Midlothian VA 23113 Oral Surgeon Chesterfield<br />
Alexander John Virginia Oral & Facial Surgery 11319 Polo Place Midlothian VA 23113 Oral Surgeon Chesterfield<br />
* Indicates dentist that is accepting current patients only.<br />
All <strong>Select</strong> <strong>Plan</strong> <strong>Dentist</strong>s Page 42<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 <strong>Dentist</strong>. Fac ID is used to indicate which facility a member chooses.
SELECT PLAN 1 DENTIST DIRECTORY<br />
<strong>Dentist</strong>s listed are under contract as of 9/1/12<br />
Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />
Dymon William Virginia Oral & Facial Surgery 11319 Polo Place Midlothian VA 23113 Oral Surgeon Chesterfield<br />
Harris Monroe Virginia Oral & Facial Surgery 11319 Polo Place Midlothian VA 23113 Oral Surgeon Chesterfield<br />
Keeney Kanyon Virginia Oral & Facial Surgery 11319 Polo Place Midlothian VA 23113 Oral Surgeon Chesterfield<br />
Metzger Lawrence Virginia Oral & Facial Surgery 11319 Polo Place Midlothian VA 23113 Oral Surgeon Chesterfield<br />
Watson Damon Virginia Oral & Facial Surgery 11319 Polo Place Midlothian VA 23113 Oral Surgeon Chesterfield<br />
Wlodawsky Ross Virginia Oral & Facial Surgery 11319 Polo Place Midlothian VA 23113 Oral Surgeon Chesterfield<br />
Patel Nrupur 000000033886 Railey Hill <strong>Dental</strong> 125 Browns Way Road Midlothian VA 23114 General Provider Chesterfield<br />
Jarvandi Fereshteh 000000000055 Fereshteh Jaravandi, D.D.S. 4712 Jefferson Davis Hwy. Richmond VA 23234 General Provider Chesterfield<br />
Stoner Kenneth 000000000036 Kenneth E Stoner DDS Family <strong>Dentist</strong>ry 4106 A Meadowdale Blvd Richmond VA 23234 General Provider Chesterfield<br />
Anderson Ralph Dr. Oley and Quilez, D.D.S., PLC 1907 West Huguenot Rd. Richmond VA 23235 Orthodontist Chesterfield<br />
Benson Wakeshi Dr. Oley and Quilez, D.D.S., PLC 1907 West Huguenot Rd. Richmond VA 23235 Orthodontist Chesterfield<br />
Gerber Sarah 000000000099 Dr. Oley and Quilez, D.D.S., PLC 1907 West Huguenot Rd. Richmond VA 23235 General Provider Chesterfield<br />
Hoover Amanda 000000000099 Dr. Oley and Quilez, D.D.S., PLC 1907 West Huguenot Rd. Richmond VA 23235 General Provider Chesterfield<br />
Oley George 000000000099 Dr. Oley and Quilez, D.D.S., PLC 1907 West Huguenot Rd. Richmond VA 23235 General Provider Chesterfield<br />
Quilez Robert 000000000099 Dr. Oley and Quilez, D.D.S., PLC 1907 West Huguenot Rd. Richmond VA 23235 General Provider Chesterfield<br />
Whitman Kime 000000000099 Dr. Oley and Quilez, D.D.S., PLC 1907 West Huguenot Rd. Richmond VA 23235 General Provider Chesterfield<br />
Saroff Stephen Stephen Saroff, D.D.S. 2801 McRae Rd. Richmond VA 23235 Periodontist Chesterfield<br />
Morrison Julius 000000000034 Julius V. Morrison, D.D.S. 3501 Courthouse Rd. Richmond VA 23236 General Provider Chesterfield<br />
Alkilani Tawfiq 000000000020 Sam E English II DDS LLC 798 Southpark Blvd., Suite 26 Colonial Heights VA 23834 General Provider Colonial Heights<br />
English, II Sam 000000000020 Sam E English II DDS LLC 798 Southpark Blvd., Suite 26 Colonial Heights VA 23834 General Provider Colonial Heights<br />
Dickson Stephanie 000000033865 Dickson <strong>Dental</strong> PC 5962 Richmond Hwy Alexandria VA 22303 General Provider Fairfax<br />
Nguyen Quynh Trang 000000001891 Virginia <strong>Dental</strong> Center 6230-C North King's Highway Alexandria VA 22303 General Provider Fairfax<br />
Nguyen Tuong-Van 000000001891 Virginia <strong>Dental</strong> Center 6230-C North King's Highway Alexandria VA 22303 General Provider Fairfax<br />
Parsa Mitra Alexandria Orthodontics 2616 Sherwood Hall Ln Alexandria VA 22306 Orthodontist Fairfax<br />
Henry Rolin Rolin S. Henry, D.D.S., P.C. 7900 Andrus Road, Suite #2 Alexandria VA 22306 Oral Surgeon Fairfax<br />
* Nguyen Steve 000000050839 Impression <strong>Dental</strong> <strong>Inc</strong>. 6167 Fuller Ct. Alexandria VA 22310 General Provider Fairfax<br />
Sharafi Alireza 000000050937 Smileville LLC 6354 Walker Ln, Suite 103 Alexandria VA 22310 General Provider Fairfax<br />
Dadkhah Mina Smileville Pediatrics 6354 Walker Ln, Suite 103 Alexandria VA 22310 Pedodontist Fairfax<br />
Kumra Shawn 000000078281 Elegant Smiles <strong>Dental</strong> Care 4810 Beauregard St, Suite 300 Alexandria VA 22312 General Provider Fairfax<br />
Khalefa Said 000000001269 Said M Khalefa DDS PC 4600 Pincrest Office Park Dr., Suite B Alexandria VA 22312 General Provider Fairfax<br />
Phan Phuong 000000050919 Kingstowne Family & Cosmetic <strong>Dentist</strong>ry 5960 Kingstowne Town Center, Suite 140 Alexandria VA 22315 General Provider Fairfax<br />
Djeu Stephanie The Virginia Endodontic Group-Kingstowne 6831Sir Viceroy Dr, Suite 210 Alexandria VA 22315 Endodontist Fairfax<br />
Lee Brian The Virginia Endodontic Group-Kingstowne 6831Sir Viceroy Dr, Suite 210 Alexandria VA 22315 Endodontist Fairfax<br />
Ngo Tu-Son The Virginia Endodontic Group-Kingstowne 6831Sir Viceroy Dr, Suite 210 Alexandria VA 22315 Endodontist Fairfax<br />
Smernoff Gerald Gerald N. Smernoff, D.D.S., PC 7501 Little River Turnpike Annandale VA 22003 Orthodontist Fairfax<br />
Vroom Katherine Katherine M. Vroom, DDS 7027 Evergreen Court Annandale VA 22003 Orthodontist Fairfax<br />
Aulakh Navdeep 000000061339 Navdeep Aulakh DDS PLLC 4231 Markham St, Suite 214 Annandale VA 22003 General Provider Fairfax<br />
Cantor David Northern Virginia Oral and Maxillofacial Surgery 7611 Little River Turnpike, Suite 101-E Annandale VA 22003 Oral Surgeon Fairfax<br />
Francioni Sonia Northern Virginia Oral and Maxillofacial Surgery 7611 Little River Turnpike, Suite 101-E Annandale VA 22003 Oral Surgeon Fairfax<br />
LaBriola J. Daniel Northern Virginia Oral and Maxillofacial Surgery 7611 Little River Turnpike, Suite 101-E Annandale VA 22003 Oral Surgeon Fairfax<br />
Zadeh Hugh Northern Virginia Oral and Maxillofacial Surgery 7611 Little River Turnpike, Suite 101-E Annandale VA 22003 Oral Surgeon Fairfax<br />
Le Thien 000000050376 Springdale <strong>Dentist</strong>ry 5105 C Backlick Rd Annandale VA 22003 General Provider Fairfax<br />
Palizi Alireza 000000050466 Alireza Palizi DDS PC 5216-A Lyngate ct. Burke VA 22015 General Provider Fairfax<br />
Gupta Raja 000000050454 <strong>Dental</strong> First Associates LLC 9570-A Burke Rd Burke VA 22015 General Provider Fairfax<br />
Jabbari Farnaz 000000000074 Hashem Sedaghatpour, D.M.D. 5631-D Burke Centre Parkway Burke VA 22015 General Provider Fairfax<br />
Kasper Frinet 000000000074 Hashem Sedaghatpour, D.M.D. 5631-D Burke Centre Parkway Burke VA 22015 General Provider Fairfax<br />
Sedaghatpour Hashem 000000000074 Hashem Sedaghatpour, D.M.D. 5631-D Burke Centre Parkway Burke VA 22015 General Provider Fairfax<br />
Pham Dieu 000000002789 Mia Pham, D.D.S. 8989 Fern Park Drive Burke VA 22015 General Provider Fairfax<br />
Naimi Amir NOVA Oral Maxillofacial & Implant Surgery 5206 Lyngate Ct Burke VA 22015 Oral Surgeon Fairfax<br />
Stern Richard Richard K. Stern, D.D.S., P.C. Burke Professional Center, 5213-B Lyngate Ct. Burke VA 22015 Orthodontist Fairfax<br />
Kim Young 000000037680 Young Smile <strong>Dental</strong> 9000 Fern Park Dr, A2 Burke VA 22015 General Provider Fairfax<br />
McDonough James James M. McDonough, D.D.S. 5731 Centre Square Dr Centreville VA 20120 Orthodontist Fairfax<br />
* Soltani Jim 000000001452 Jim J. Soltani, D.D.S. & Associates, P.C. 6019 Centreville Crest Lane Centreville VA 20121 General Provider Fairfax<br />
Filippone Louis Louis C Filippone DDS PC 6138 Redwood Sq, Suite 103 Centreville VA 20121 Orthodontist Fairfax<br />
Kim JoongSeo Pearlbrite <strong>Dental</strong> Group PLLC 14631 Lee Highway, Suite 116 Centreville VA 20121 Prosthodontist Fairfax<br />
Ali Wissam 000000037712 Relaxed <strong>Dentist</strong>ry 14631 Lee Hwy, 301 Centreville VA 20121 General Provider Fairfax<br />
Ayass Mohamad 000000061304 Relaxed <strong>Dentist</strong>ry 14631 Lee Hwy, Suite 301 Centreville VA 20121 General Provider Fairfax<br />
Shu Man 000000061402 V Care <strong>Dental</strong> LLC 14631 Lee Hwy, Suite 117 Centreville VA 20121 General Provider Fairfax<br />
Huynh Thuylinh Chantilly <strong>Dental</strong> Center Orthodontics 3901 Centreview Dr, Suite T Chantilly VA 20151 Orthodontist Fairfax<br />
Galliani Alvare Mirtha Chantilly <strong>Dental</strong> Center Specialists 3901 Centreview Dr, Suite T Chantilly VA 20151 Pedodontist Fairfax<br />
Lan Steve Chantilly <strong>Dental</strong> Center Specialists 3901 Centreview Dr, Suite T Chantilly VA 20151 Pedodontist Fairfax<br />
Liewehr Frederick Chantilly <strong>Dental</strong> Center Specialists 3901 Centreview Dr, Suite T Chantilly VA 20151 Endodontist Fairfax<br />
Nguyen Phuong Chantilly <strong>Dental</strong> Center Specialists 3901 Centreview Dr, Suite T Chantilly VA 20151 Oral Surgeon Fairfax<br />
Baveja Julie Children's <strong>Dental</strong> Care 14102 Robert Paris Ct Chantilly VA 20151 Pedodontist Fairfax<br />
Ali Amal 000000037667 Diamond <strong>Dental</strong> Care 13948 Lee Jackson Memorial Hwy Chantilly VA 20151 General Provider Fairfax<br />
Johnson Gary Diamond <strong>Dental</strong> Care Endodontist 13948 Lee Jackson Mem Hwy Chantilly VA 20151 Endodontist Fairfax<br />
* Indicates dentist that is accepting current patients only.<br />
All <strong>Select</strong> <strong>Plan</strong> <strong>Dentist</strong>s Page 43<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 <strong>Dentist</strong>. Fac ID is used to indicate which facility a member chooses.
SELECT PLAN 1 DENTIST DIRECTORY<br />
<strong>Dentist</strong>s listed are under contract as of 9/1/12<br />
Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />
Beri Anuradha Diamond <strong>Dental</strong> Care Specialists 13948 Lee Jackson Mem Hwy Chantilly VA 20151 Periodontist Fairfax<br />
* Chaenkwok Don 000000001387 Donald Chaenkwok, D.D.S. 14012B Sullyfield Circle Chantilly VA 20151 General Provider Fairfax<br />
Djeu Stephanie The Virginia Endodontic Group PLC 14149-B Robert Paris Ct. Chantilly VA 20151 Endodontist Fairfax<br />
Huang Tong-Yen The Virginia Endodontic Group PLC 14149-B Robert Paris Ct. Chantilly VA 20151 Endodontist Fairfax<br />
Lee Brian The Virginia Endodontic Group PLC 14149-B Robert Paris Ct. Chantilly VA 20151 Endodontist Fairfax<br />
Ngo Tu-Son The Virginia Endodontic Group PLC 14149-B Robert Paris Ct. Chantilly VA 20151 Endodontist Fairfax<br />
Papp Richard 000000070989 Westfields <strong>Dentist</strong>ry 4530 Walney Rd, Suite 102 Chantilly VA 20151 General Provider Fairfax<br />
Zamora-Rojas Carla 000000070989 Westfields <strong>Dentist</strong>ry 4530 Walney Rd, Suite 102 Chantilly VA 20151 General Provider Fairfax<br />
Berman Robert 000000000217 Drs Berman & Miller DDS 9942 Main Street Fairfax VA 22031 General Provider Fairfax<br />
Miller Jeffrey 000000000217 Drs Berman & Miller DDS 9942 Main Street Fairfax VA 22031 General Provider Fairfax<br />
Banawar Rohini 000000000523 Howard Hoffman, D.D.S., P.C. 9661 -C Main Street Fairfax VA 22031 General Provider Fairfax<br />
Colospate Vidya 000000000523 Howard Hoffman, D.D.S., P.C. 9661 -C Main Street Fairfax VA 22031 General Provider Fairfax<br />
Hoffman Howard 000000000523 Howard Hoffman, D.D.S., P.C. 9661 -C Main Street Fairfax VA 22031 General Provider Fairfax<br />
Nguyen Nikki Howard Hoffman, D.D.S., P.C. 9661 -C Main Street Fairfax VA 22031 Orthodontist Fairfax<br />
Rahman Murshad 000000000523 Howard Hoffman, D.D.S., P.C. 9661 -C Main Street Fairfax VA 22031 General Provider Fairfax<br />
Wang Peng 000000000523 Howard Hoffman, D.D.S., P.C. 9661 -C Main Street Fairfax VA 22031 General Provider Fairfax<br />
Zurmati Farid 000000000523 Howard Hoffman, D.D.S., P.C. 9661 -C Main Street Fairfax VA 22031 General Provider Fairfax<br />
Chou Melanie Howard Hoffman, D.D.S., P.C. Specialists 9661 C Main St Fairfax VA 22031 Periodontist Fairfax<br />
Kessler Joel Howard Hoffman, D.D.S., P.C. Specialists 9661 C Main St Fairfax VA 22031 Endodontist Fairfax<br />
Le Kathy Howard Hoffman, D.D.S., P.C. Specialists 9661 C Main St Fairfax VA 22031 Endodontist Fairfax<br />
McDonough James James M. McDonough, D.D.S. 9508-B Lee Hwy. Fairfax VA 22031 Orthodontist Fairfax<br />
Choi Mark 000000002255 Mark K. Choi, D.D.S., P.C. 8301 Arlington Boulevard, Suite 503 Fairfax VA 22031 General Provider Fairfax<br />
Small Neil Neil J. Small, D.D.S., PC 9940 Main Street Fairfax VA 22031 Endodontist Fairfax<br />
Le Trung 000000037961 Trung Q. Le, DDS 9600-I Main St Fairfax VA 22031 General Provider Fairfax<br />
Joo Chuck 000000002529 Chuck C. Joo, D.M.D. 12011 Lee Jackson Mem. Hwy., 104 Fairfax VA 22033 General Provider Fairfax<br />
Suk Minjeong 000000050398 Minjeong Suk DDS PC 4001 Fair Ridge Dr, Suite 105 Fairfax VA 22033 General Provider Fairfax<br />
Jaber Margarita 000000037710 Mira <strong>Dental</strong> Care 5671 Columbia Pike, 101 Falls Church VA 22041 General Provider Fairfax<br />
Mogharbel Tarek 000000037710 Mira <strong>Dental</strong> Care 5671 Columbia Pike, 101 Falls Church VA 22041 General Provider Fairfax<br />
Mohiuddin Sumayra 000000037710 Mira <strong>Dental</strong> Care 5671 Columbia Pike, 101 Falls Church VA 22041 General Provider Fairfax<br />
Coleman Norman Norman K. Coleman, D.D.S. 5205 Leesburg Pike, #509 Falls Church VA 22041 Oral Surgeon Fairfax<br />
Amouhashem Parvin 000000001544 Smile <strong>Dental</strong> Clinic 3817-A S. George Mason Drive Falls Church VA 22041 General Provider Fairfax<br />
Nassar Fadwa 000000002845 Falls Church Family and Comprehensive <strong>Dentist</strong>ry 6400 Arlington Blvd., Suite 944 Falls Church VA 22042 General Provider Fairfax<br />
* Kangarloo Ramineh 000000050943 Gentle Touch <strong>Dentist</strong>ry for All Ages 6521 Arlington Blvd, Suite 112 Falls Church VA 22042 General Provider Fairfax<br />
Kaur Taran 000000002124 Optimum <strong>Dental</strong> 7389 Lee Highway, Suite 101 Falls Church VA 22042 General Provider Fairfax<br />
Shroff Amisha 000000050547 Apt <strong>Dental</strong> Associates 7115 Leesburg Pike, Suite 216 Falls Church VA 22043 General Provider Fairfax<br />
Moller James 000000000815 Drs. Seigel & Moller 7641 Leesburg Pike Falls Church VA 22043 General Provider Fairfax<br />
Seigel Harold 000000000815 Drs. Seigel & Moller 7641 Leesburg Pike Falls Church VA 22043 General Provider Fairfax<br />
Kermanshi Shiva Arlington <strong>Dental</strong> Care PLLC 6060 Arlington Blvd. Falls Church VA 22044 Orthodontist Fairfax<br />
Solemaninejad Homan 000000033844 Arlington <strong>Dental</strong> Care PLLC 6060 Arlington Blvd. Falls Church VA 22044 General Provider Fairfax<br />
Vu Bao Bao T. Vu, D.D.S. 6081 Arlington Blvd. Falls Church VA 22044 Orthodontist Fairfax<br />
Patterson Travis Drs. Whiston, Patterson & Corcoran 6400 Arlington Blvd., Plaza 1 Lower Level Falls Church VA 22044 Oral Surgeon Fairfax<br />
Gregory Eugene Eugene W. Gregory, D.D.S. 6231 Leesburg Pike #402 Falls Church VA 22044 Oral Surgeon Fairfax<br />
Dang Quynh-Anh 000000051063 Sleepy Hollow <strong>Dental</strong> PLLC 2946 Sleepy Hollow Rd, Suite 1B Falls Church VA 22044 General Provider Fairfax<br />
Le Yen 000000051063 Sleepy Hollow <strong>Dental</strong> PLLC 2946 Sleepy Hollow Rd, Suite 1B Falls Church VA 22044 General Provider Fairfax<br />
Doppalapudi Vivek Vivek Doppalapudi, D.D.S. 102 Elden St., Ste 19 Herndon VA 20170 Periodontist Fairfax<br />
Alayssami Mazin 000000000092 Bright Now <strong>Dental</strong> 13873 Park Center Rd., Suite 137 Herndon VA 20171 General Provider Fairfax<br />
Byrd Richard Bright Now <strong>Dental</strong> 13873 Park Center Rd., Suite 137 Herndon VA 20171 Orthodontist Fairfax<br />
Chaddad Karim Bright Now <strong>Dental</strong> 13873 Park Center Rd., Suite 137 Herndon VA 20171 Periodontist Fairfax<br />
Devylder Joseph Bright Now <strong>Dental</strong> 13873 Park Center Rd., Suite 137 Herndon VA 20171 Oral Surgeon Fairfax<br />
Ornoff Mark 000000000092 Bright Now <strong>Dental</strong> 13873 Park Center Rd., Suite 137 Herndon VA 20171 General Provider Fairfax<br />
Reedy Hima-Bindu 000000000092 Bright Now <strong>Dental</strong> 13873 Park Center Rd., Suite 137 Herndon VA 20171 General Provider Fairfax<br />
Chaddad Karim Mazin Alayssami DMD & Associates PC Specialists 13873 Park Center Rd, Suite 137 Herndon VA 20171 Periodontist Fairfax<br />
DeVylder Joseph Mazin Alayssami DMD & Associates PC Specialists 13873 Park Center Rd, Suite 137 Herndon VA 20171 Oral Surgeon Fairfax<br />
Kuppam Swathi All Smiles Orthodontics 9010 Lorton Station Blvd, Suite 260 Lorton VA 22079 Orthodontist Fairfax<br />
Patel Snehal Snehal Patel DDS 9010 Lorton Station Blvd, Suite 140 Lorton VA 22079 Oral Surgeon Fairfax<br />
Mogharbel Tarek 000000051125 Mira <strong>Dental</strong> Care at Tysons Corner 8201 Greensboro Dr, Suite 710 Mc Lean VA 22102 General Provider Fairfax<br />
Bajwa Preet 000000061412 A B <strong>Dental</strong> 11790 H Baron Cameron Ave Reston VA 20190 General Provider Fairfax<br />
Bordon Elda 000000079058 Family and Cosmetic <strong>Dentist</strong>ry 1800 Michael Faraday Dr Reston VA 20190 General Provider Fairfax<br />
Naimi Amir NOVA Oral Maxillofacial & Implant Surgery 11331 Sunset Hills Rd Reston VA 20190 Oral Surgeon Fairfax<br />
Pell James Oral Surgery Associates of Northern Virginia Ltd 1800 Town Center Drive, Suite116 Reston VA 20190 Oral Surgeon Fairfax<br />
Wang Richard Oral Surgery Associates of Northern Virginia Ltd 1800 Town Center Drive, Suite116 Reston VA 20190 Oral Surgeon Fairfax<br />
Anoushfar Sherry 000000000926 Sherry Anoushfar, D.D.S., PC 1984 Isaac Newton Square, Suite 201 Reston VA 20190 General Provider Fairfax<br />
Izadi Moshen 000000000926 Sherry Anoushfar, D.D.S., PC 1984 Isaac Newton Square, Suite 201 Reston VA 20190 General Provider Fairfax<br />
Khang Wahn Perio Implant Center 11866 Sunrise Valley Drive, Suite 101 Reston VA 20191 Periodontist Fairfax<br />
Colospate Vidya 000000000524 Howard Hoffman, D.D.S., P.C. 6340 Brandon Ave. Springfield VA 22150 General Provider Fairfax<br />
Grande Marcos 000000000524 Howard Hoffman, D.D.S., P.C. 6340 Brandon Ave. Springfield VA 22150 General Provider Fairfax<br />
* Indicates dentist that is accepting current patients only.<br />
All <strong>Select</strong> <strong>Plan</strong> <strong>Dentist</strong>s Page 44<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 <strong>Dentist</strong>. Fac ID is used to indicate which facility a member chooses.
SELECT PLAN 1 DENTIST DIRECTORY<br />
<strong>Dentist</strong>s listed are under contract as of 9/1/12<br />
Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />
Hoffman Howard 000000000524 Howard Hoffman, D.D.S., P.C. 6340 Brandon Ave. Springfield VA 22150 General Provider Fairfax<br />
Nguyen Nikki Howard Hoffman, D.D.S., P.C. 6340 Brandon Ave. Springfield VA 22150 Orthodontist Fairfax<br />
Zarookian Armen 000000000524 Howard Hoffman, D.D.S., P.C. 6340 Brandon Ave. Springfield VA 22150 General Provider Fairfax<br />
Zurmati Farid 000000000524 Howard Hoffman, D.D.S., P.C. 6340 Brandon Ave. Springfield VA 22150 General Provider Fairfax<br />
Chou Melanie Howard Hoffman, D.D.S., P.C. Specialists 6340 Brandon Ave Springfield VA 22150 Periodontist Fairfax<br />
Gutmann J. J. Steven Gutmann, D.D.S., P.C. 6225 Brandon Ave., #185 Springfield VA 22150 Oral Surgeon Fairfax<br />
Sina Nadia MY BRACES DOCTOR, PC 6525-C Frontier Dr. Springfield VA 22150 Orthodontist Fairfax<br />
Khalefa Said 000000000048 Said M. Khalefa, D.D.S., P.C. 6115 Backlick Rd Springfield VA 22150 General Provider Fairfax<br />
Alayssami Mazin 000000000145 Bright Now <strong>Dental</strong> 2230 Gallows Rd., Suite 320 Vienna VA 22027 General Provider Fairfax<br />
Elkhateeb Mohammad 000000000145 Bright Now <strong>Dental</strong> 2230 Gallows Rd., Suite 320 Vienna VA 22027 General Provider Fairfax<br />
Chaddad Karim Mazin Alayssami DMD & Associates PC Specialists 2230 Gallows Rd, Suite 320 Vienna VA 22027 Periodontist Fairfax<br />
DeVylder Joseph Mazin Alayssami DMD & Associates PC Specialists 2230 Gallows Rd, Suite 320 Vienna VA 22027 Oral Surgeon Fairfax<br />
Patel Ashish Mazin Alayssami DMD & Associates PC Specialists 2230 Gallows Rd, Suite 320 Vienna VA 22027 Oral Surgeon Fairfax<br />
Schiff Basil Basil A. Schiff, D.D.S., P.C. 361 Maple Ave W, Suite 200 Vienna VA 22180 Oral Surgeon Fairfax<br />
Luna Oscar Bright Smile Pediatric <strong>Dentist</strong> 410 Pine St SE Vienna VA 22180 Pedodontist Fairfax<br />
Zadeh David 000000033866 Davoud Zadeh, D.D.S. 308 <strong>Dominion</strong> Rd. N.E. Vienna VA 22180 General Provider Fairfax<br />
Kim JoongSeo JoongSeo Kim, D.D.S., PC 301 Maple Ave West, Suite 610 Vienna VA 22180 Prosthodontist Fairfax<br />
DeVylder Joseph Joseph J. DeVylder, D.D.S. 407-F Church St., NE Vienna VA 22180 Oral Surgeon Fairfax<br />
Kim Sang Oral Facial and <strong>Dental</strong> Implant Surgery 361 Maple Ave West, Suite 200 Vienna VA 22180 Oral Surgeon Fairfax<br />
Dellork Richard Richard J Dellork DDS 124 Park St SE, Suite 205 Vienna VA 22180 Endodontist Fairfax<br />
Iravani Farideh Dr. Farideh Irvani, DMD-Spec 1964 Gallows Road #220 Vienna VA 22182 Periodontist Fairfax<br />
Johnson Gary Gary J. Johnson, DDS 8227 Old Courthouse Rd, 201 Vienna VA 22182 Endodontist Fairfax<br />
* Le Quan 000000000115 Le Smile 2070 Chain Bridge Rd., Suite 530 Vienna VA 22182 General Provider Fairfax<br />
Choby Mary Mary Ann Choby, D.M.D., MS 8133 Leesburg Pike, Suite 610 Vienna VA 22182 Endodontist Fairfax<br />
Anoushfar Sherry 000000001302 Sherry Anoushfar, D.D.S., PC 133 East Maple Avenue, Suite 206 Vienna VA 22182 General Provider Fairfax<br />
Izadi Moshen 000000001302 Sherry Anoushfar, D.D.S., PC 133 East Maple Avenue, Suite 206 Vienna VA 22182 General Provider Fairfax<br />
Alvarez Juan Tysons Corner <strong>Dentist</strong>s 8296-A Old Courthouse Rd. Vienna VA 22182 Prosthodontist Fairfax<br />
Imao Josemari 000000033870 Tysons Corner <strong>Dentist</strong>s 8296-A Old Courthouse Rd. Vienna VA 22182 General Provider Fairfax<br />
Ribeiro Alexandre 000000033870 Tysons Corner <strong>Dentist</strong>s 8296-A Old Courthouse Rd. Vienna VA 22182 General Provider Fairfax<br />
Shu Man 000000033870 Tysons Corner <strong>Dentist</strong>s 8296-A Old Courthouse Rd. Vienna VA 22182 General Provider Fairfax<br />
Sperling-Habot Keren Tysons Corner <strong>Dentist</strong>s Specialists 8296 A Old Courthouse Rd Vienna VA 22182 Periodontist Fairfax<br />
Fariello Arnold 000000037553 Arnold S. Fariello, D.D.S., PC 10875 Main St., #103 Fairfax VA 22030 General Provider Fairfax City<br />
Hong Charlie Charlie H. Hong, DMD, PC 3554 Chain Bridge Rd., Suite 401 Fairfax VA 22030 Endodontist Fairfax City<br />
Hsu Yu Kai Charlie H. Hong, DMD, PC 3554 Chain Bridge Rd., Suite 401 Fairfax VA 22030 Endodontist Fairfax City<br />
Butt Tehreem 000000037738 Family <strong>Dentist</strong>ry of Fairfax, PC 10391 Democracy Lane, Suite A Fairfax VA 22030 General Provider Fairfax City<br />
Sina Nadia MY BRACES DOCTOR, PC 3925 Old Lee Hwy, Unit 51 C Fairfax VA 22030 Orthodontist Fairfax City<br />
Yoon Jangyeul 000000037759 Thomas Yoon <strong>Dental</strong> 10807 Main St, 200 Fairfax VA 22030 General Provider Fairfax City<br />
* Boyce Albert 000000000358 Albert M. Boyce, D.D.S. 313 Park Ave., Suite 101 Falls Church VA 22046 General Provider Falls Church City<br />
Sarraj Ali 000000001322 Ali Sarraj, D.M.D. & Associates, P.C. 932 West Broad St. Falls Church VA 22046 General Provider Falls Church City<br />
Christopher Lourdes Christopher & Favagehi, D.D.S., M.S. 313 Park Avenue, Suite 103 Falls Church VA 22046 Periodontist Falls Church City<br />
Favagehi Mehrdad Christopher & Favagehi, D.D.S., M.S. 313 Park Avenue, Suite 103 Falls Church VA 22046 Periodontist Falls Church City<br />
Khattak Farida 000000061384 Dynamic <strong>Dental</strong> PC 159 Hillwood Ave Falls Church VA 22046 General Provider Falls Church City<br />
Christopher Lourdes Perio & <strong>Dental</strong> Implant Surgery Ctr of Falls Church 313 Park Ave., Suite 103 Falls Church VA 22046 Periodontist Falls Church City<br />
Deutsch Charles Perio & <strong>Dental</strong> Implant Surgery Ctr of Falls Church 313 Park Ave., Suite 103 Falls Church VA 22046 Periodontist Falls Church City<br />
Favagehi Mehrdad Perio & <strong>Dental</strong> Implant Surgery Ctr of Falls Church 313 Park Ave., Suite 103 Falls Church VA 22046 Periodontist Falls Church City<br />
Rekow Marlin 000000078269 Marlin F Rekow DDS PC 127 E Shirley Ave Warrenton VA 20186 General Provider Fauquier<br />
Terrill David David Terrill, D.D.S. 1300 Thornton St. Fredericksburg VA 22401 Orthodontist Fredericksburg City<br />
Ahmed Gaafar 000000001730 <strong>Dental</strong> One Associates Fredericksburg PC 201 Park Hill Drive Fredericksburg VA 22401 General Provider Fredericksburg City<br />
Amin Ahmad <strong>Dental</strong> One Associates Fredericksburg PC 201 Park Hill Drive Fredericksburg VA 22401 Oral Surgeon Fredericksburg City<br />
Dayse Robert <strong>Dental</strong> One Associates Fredericksburg PC 201 Park Hill Drive Fredericksburg VA 22401 Oral Surgeon Fredericksburg City<br />
Gupta Raja 000000001730 <strong>Dental</strong> One Associates Fredericksburg PC 201 Park Hill Drive Fredericksburg VA 22401 General Provider Fredericksburg City<br />
Hukmani Navin <strong>Dental</strong> One Associates Fredericksburg PC 201 Park Hill Drive Fredericksburg VA 22401 Orthodontist Fredericksburg City<br />
Le Tuan 000000001730 <strong>Dental</strong> One Associates Fredericksburg PC 201 Park Hill Drive Fredericksburg VA 22401 General Provider Fredericksburg City<br />
Lin Thomas <strong>Dental</strong> One Associates Fredericksburg PC 201 Park Hill Drive Fredericksburg VA 22401 Periodontist Fredericksburg City<br />
Yoo Junghoon 000000001730 <strong>Dental</strong> One Associates Fredericksburg PC 201 Park Hill Drive Fredericksburg VA 22401 General Provider Fredericksburg City<br />
Willoughby Tasha 000000068492 Tranquility <strong>Dental</strong> Center PLLC 2557 Cowan Blvd Fredericksburg VA 22401 General Provider Fredericksburg City<br />
* Chung John 000000050569 John Chung DDS PC 1959 E Pembroke Ave Hampton VA 23663 General Provider Hampton City<br />
Scott Jon Jon L. Scott, D.D.S., M.S. 2108 Hartford Rd Hampton VA 23666 Orthodontist Hampton City<br />
Park Kyeong 000000002844 Kyeong Park DDS 21 Towne Center Way Hampton VA 23666 General Provider Hampton City<br />
Modeste Lorenzo 000000000029 Lorenzo J. Modeste, D.D.S. 2238 West Todds Lane, Suite C Hampton VA 23666 General Provider Hampton City<br />
Barnes Richard 000000000030 Richard D. Barnes, D.D.S. 2240 Coliseum Dr., Suite C Hampton VA 23666 General Provider Hampton City<br />
Klochak Joseph 000000000030 Richard D. Barnes, D.D.S. 2240 Coliseum Dr., Suite C Hampton VA 23666 General Provider Hampton City<br />
Gallop Ceceil 000000000038 Ceceil C. Gallop, D.D.S. 3709 Kecoughtan Rd Hampton VA 23669 General Provider Hampton City<br />
Robinson Donald 000000000039 Donald C. Robinson, D.D.S. 3709 Kecoughtan Rd. Hampton VA 23669 General Provider Hampton City<br />
Ross Edward Edward F. Ross, Jr., D.D.S., Ltd. 130 Thompson Street Ashland VA 23005 Orthodontist Hanover<br />
Shait Abraham Abraham Shait, D.D.S., Ltd. 7239 Mechanicsville Tpke. Mechanicsville VA 23111 Periodontist Hanover<br />
* Indicates dentist that is accepting current patients only.<br />
All <strong>Select</strong> <strong>Plan</strong> <strong>Dentist</strong>s Page 45<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 <strong>Dentist</strong>. Fac ID is used to indicate which facility a member chooses.
SELECT PLAN 1 DENTIST DIRECTORY<br />
<strong>Dentist</strong>s listed are under contract as of 9/1/12<br />
Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />
Khara Amanjot 000000001065 Amanjot Khara, D.D.S., P.C. 6372 Mechanicsville Tpke., Suite 106 Mechanicsville VA 23111 General Provider Hanover<br />
Ross Edward Edward F. Ross, Jr., D.D.S., Ltd. 7281 Hanover Green Drive Mechanicsville VA 23111 Orthodontist Hanover<br />
Lee Kyu 000000037532 K.J. Lee, D.M.D., PC 7347 Bell Creek Rd, Suite # 400 Mechanicsville VA 23111 General Provider Hanover<br />
* Jordan Morris 000000000299 Morris L Jordan DDS 7239 Mechanicsville Trnpk. Mechanicsville VA 23111 General Provider Hanover<br />
Murphy Walter Walter K. Murphy, D.D.S., P.C. 7009 Lee Park Rd. Mechanicsville VA 23111 Oral Surgeon Hanover<br />
English, II Sam 000000000018 Sam E English II DDS Ltd 8220 Windmill Watch Drive Mechanicsville VA 23116 General Provider Hanover<br />
Agnihotri Neil Virginia Oral & Facial Surgery 7481 Right Flank Road, Suite 120 Mechanicsville VA 23116 Oral Surgeon Hanover<br />
Dymon William Virginia Oral & Facial Surgery 7481 Right Flank Road, Suite 120 Mechanicsville VA 23116 Oral Surgeon Hanover<br />
Harris Monroe Virginia Oral & Facial Surgery 7481 Right Flank Road, Suite 120 Mechanicsville VA 23116 Oral Surgeon Hanover<br />
Keeney Kanyon Virginia Oral & Facial Surgery 7481 Right Flank Road, Suite 120 Mechanicsville VA 23116 Oral Surgeon Hanover<br />
Metzger Lawrence Virginia Oral & Facial Surgery 7481 Right Flank Road, Suite 120 Mechanicsville VA 23116 Oral Surgeon Hanover<br />
Watson Damon Virginia Oral & Facial Surgery 7481 Right Flank Road, Suite 120 Mechanicsville VA 23116 Oral Surgeon Hanover<br />
Damirchi Nasser 000000037683 Nasser Damirchi D.D.S., P.C. 5243 Hickory Park Dr, Suite D Glen Allen VA 23059 General Provider Henrico<br />
* Anderson Bradley 000000000300 Bradley R. Anderson, D.D.S. 11420 West Broad St. Glen Allen VA 23060 General Provider Henrico<br />
* Hackett, Jr. Charles 000000002542 Charles Hackett, Jr., D.D.S., P.C. 1807 Libbie Avenue, Suite 100 Richmond VA 23226 General Provider Henrico<br />
Garfield Dean 000000001984 Garfield Family <strong>Dentist</strong>ry 5500 Monument Ave., Suite G Richmond VA 23226 General Provider Henrico<br />
Agnihotri Neil Virginia Oral & Facial Surgery 5224 Monument Ave, Suite 100 Richmond VA 23226 Oral Surgeon Henrico<br />
Alexander John Virginia Oral & Facial Surgery 5224 Monument Ave, Suite 100 Richmond VA 23226 Oral Surgeon Henrico<br />
Dymon William Virginia Oral & Facial Surgery 5224 Monument Ave, Suite 100 Richmond VA 23226 Oral Surgeon Henrico<br />
Harris Monroe Virginia Oral & Facial Surgery 5224 Monument Ave, Suite 100 Richmond VA 23226 Oral Surgeon Henrico<br />
Keeney Kanyon Virginia Oral & Facial Surgery 5224 Monument Ave, Suite 100 Richmond VA 23226 Oral Surgeon Henrico<br />
Metzger Lawrence Virginia Oral & Facial Surgery 5224 Monument Ave, Suite 100 Richmond VA 23226 Oral Surgeon Henrico<br />
Watson Damon Virginia Oral & Facial Surgery 5224 Monument Ave, Suite 100 Richmond VA 23226 Oral Surgeon Henrico<br />
Wlodawsky Ross Virginia Oral & Facial Surgery 5224 Monument Ave, Suite 100 Richmond VA 23226 Oral Surgeon Henrico<br />
* Jessup Ronald 000000000049 Ronald J. Jessup, D.D.S. 1130 Wilkinson Road Richmond VA 23227 General Provider Henrico<br />
Newberry William 000000000087 William L. Newberry, D.D.S. 1717 Bellevue Ave., Imperial Plaza Richmond VA 23227 General Provider Henrico<br />
Anderson Ralph George A. Oley, III, D.D.S. 9030 Three Chopt Road, Suite A Richmond VA 23229 Orthodontist Henrico<br />
Benson Wakeshi George A. Oley, III, D.D.S. 9030 Three Chopt Road, Suite A Richmond VA 23229 Orthodontist Henrico<br />
Hoover Amanda 000000000014 George A. Oley, III, D.D.S. 9030 Three Chopt Road, Suite A Richmond VA 23229 General Provider Henrico<br />
Ibrahim Karmen 000000000014 George A. Oley, III, D.D.S. 9030 Three Chopt Road, Suite A Richmond VA 23229 General Provider Henrico<br />
Kennealy Sarah 000000000014 George A. Oley, III, D.D.S. 9030 Three Chopt Road, Suite A Richmond VA 23229 General Provider Henrico<br />
Kopelove Stephen 000000000014 George A. Oley, III, D.D.S. 9030 Three Chopt Road, Suite A Richmond VA 23229 General Provider Henrico<br />
Oley George 000000000014 George A. Oley, III, D.D.S. 9030 Three Chopt Road, Suite A Richmond VA 23229 General Provider Henrico<br />
Poquis Gregory 000000000014 George A. Oley, III, D.D.S. 9030 Three Chopt Road, Suite A Richmond VA 23229 General Provider Henrico<br />
Quilez Robert 000000000014 George A. Oley, III, D.D.S. 9030 Three Chopt Road, Suite A Richmond VA 23229 General Provider Henrico<br />
Wilby Lyla Rose 000000000014 George A. Oley, III, D.D.S. 9030 Three Chopt Road, Suite A Richmond VA 23229 General Provider Henrico<br />
Da Cunha Paul 000000002718 Paul Da Cunha DMD PC 8503 Patterson Ave, Suite C Richmond VA 23229 General Provider Henrico<br />
Stoner Kenneth 000000000040 Kenneth E. Stoner, D.D.S. & Associates 4922 W. Broad St., Westend Richmond VA 23230 General Provider Henrico<br />
Hendrickson-Hai Joelle 000000002614 Great Expressions, Jack Falvo, DDS 4859 Finlay Street Richmond VA 23231 General Provider Henrico<br />
Sekhon Navneet 000000002614 Great Expressions, Jack Falvo, DDS 4859 Finlay Street Richmond VA 23231 General Provider Henrico<br />
Hudson Raidah 000000000015 Raidah Hudson, D.D.S., P.C. 4374 S. Laburnum Avenue Richmond VA 23231 General Provider Henrico<br />
* Osman Feisal 000000000766 Feisal Osman 3033 Lauderdale Drive Richmond VA 23233 General Provider Henrico<br />
* Hudson Paul 000000000047 Hudson & Hudson PC 1801 Raintree Dr, Suite A Richmond VA 23238 General Provider Henrico<br />
Shait Abraham Abraham Shait, D.D.S., Ltd. 3210 Skipwith Rd. Richmond VA 23294 Periodontist Henrico<br />
Agnihotri Neil Virginia Oral & Facial Surgery 7650 Parham Rd., Suite 110 Richmond VA 23294 Oral Surgeon Henrico<br />
Alexander John Virginia Oral & Facial Surgery 7650 Parham Rd., Suite 110 Richmond VA 23294 Oral Surgeon Henrico<br />
Dymon William Virginia Oral & Facial Surgery 7650 Parham Rd., Suite 110 Richmond VA 23294 Oral Surgeon Henrico<br />
Harris Monroe Virginia Oral & Facial Surgery 7650 Parham Rd., Suite 110 Richmond VA 23294 Oral Surgeon Henrico<br />
Keeney Kanyon Virginia Oral & Facial Surgery 7650 Parham Rd., Suite 110 Richmond VA 23294 Oral Surgeon Henrico<br />
Metzger Lawrence Virginia Oral & Facial Surgery 7650 Parham Rd., Suite 110 Richmond VA 23294 Oral Surgeon Henrico<br />
Watson Damon Virginia Oral & Facial Surgery 7650 Parham Rd., Suite 110 Richmond VA 23294 Oral Surgeon Henrico<br />
Agnihotri Neil Virginia Oral & Facial Surgery 5510 Whiteside Dr Sandston VA 23150 Oral Surgeon Henrico<br />
Alexander John Virginia Oral & Facial Surgery 5510 Whiteside Dr Sandston VA 23150 Oral Surgeon Henrico<br />
Dymon William Virginia Oral & Facial Surgery 5510 Whiteside Dr Sandston VA 23150 Oral Surgeon Henrico<br />
Harris Monroe Virginia Oral & Facial Surgery 5510 Whiteside Dr Sandston VA 23150 Oral Surgeon Henrico<br />
Keeney Kanyon Virginia Oral & Facial Surgery 5510 Whiteside Dr Sandston VA 23150 Oral Surgeon Henrico<br />
Metzger Lawrence Virginia Oral & Facial Surgery 5510 Whiteside Dr Sandston VA 23150 Oral Surgeon Henrico<br />
Watson Damon Virginia Oral & Facial Surgery 5510 Whiteside Dr Sandston VA 23150 Oral Surgeon Henrico<br />
Avram Adrian 000000000019 Sam E English II DDS Ltd 5303 Plaza Drive, Suite 103 Hopewell VA 23860 General Provider Hopewell City<br />
English, II Sam 000000000019 Sam E English II DDS Ltd 5303 Plaza Drive, Suite 103 Hopewell VA 23860 General Provider Hopewell City<br />
Nguyen Kim 000000000019 Sam E English II DDS Ltd 5303 Plaza Drive, Suite 103 Hopewell VA 23860 General Provider Hopewell City<br />
English, II Sam 000000002647 Sam E English II DDS LLC 4680-16A Monticello Ave. Williamsburg VA 23188 General Provider James City<br />
Raphael Jeff 000000002647 Sam E English II DDS LLC 4680-16A Monticello Ave. Williamsburg VA 23188 General Provider James City<br />
Rhyne Katherine 000000002647 Sam E English II DDS LLC 4680-16A Monticello Ave. Williamsburg VA 23188 General Provider James City<br />
Coker John John H Coker Jr DMD 9449 Grover Dr, 100 King George VA 22485 Orthodontist King George<br />
English, II Sam 000000000009 Sam E English II DDS Ltd 628 Main St. West Point VA 23181 General Provider King William<br />
* Indicates dentist that is accepting current patients only.<br />
All <strong>Select</strong> <strong>Plan</strong> <strong>Dentist</strong>s Page 46<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 <strong>Dentist</strong>. Fac ID is used to indicate which facility a member chooses.
SELECT PLAN 1 DENTIST DIRECTORY<br />
<strong>Dentist</strong>s listed are under contract as of 9/1/12<br />
Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />
Raphael Jeff 000000000009 Sam E English II DDS Ltd 628 Main St. West Point VA 23181 General Provider King William<br />
Eghtessad Mohammed 000000037695 Gateway <strong>Dental</strong> 44330 Premier Plaza, 140 Ashburn VA 20147 General Provider Loudoun<br />
Chaddad Karim Gateway <strong>Dental</strong> Specialists 44330 Premier Plaza, Suite 140 Ashburn VA 20147 Periodontist Loudoun<br />
Patel Ajit Ashburn Pediatric <strong>Dental</strong> Center 42882 Truro Parish Dr, Suite 205 Ashburn VA 20148 Pedodontist Loudoun<br />
Longwe Edward Dulles Oral Surgical Center 24805 Pinebrook Rd, Suite 100 Chantilly VA 20152 Oral Surgeon Loudoun<br />
Omar Anisa East Gate Orthodontics 25401 Eastern Marketplace Plz, Suite 195 Chantilly VA 20152 Orthodontist Loudoun<br />
Amin Ahmad South Riding <strong>Dental</strong> Associates, P.C. 25055 Riding Plaza Dr., Suite 270 Chantilly VA 20152 Oral Surgeon Loudoun<br />
Hukmani Navin South Riding <strong>Dental</strong> Associates, P.C. 25055 Riding Plaza Dr., Suite 270 Chantilly VA 20152 Orthodontist Loudoun<br />
Huynh Thuylinh South Riding <strong>Dental</strong> Associates, P.C. 25055 Riding Plaza Dr., Suite 270 Chantilly VA 20152 Orthodontist Loudoun<br />
Valleru Silvija 000000037730 South Riding <strong>Dental</strong> Associates, P.C. 25055 Riding Plaza Dr., Suite 270 Chantilly VA 20152 General Provider Loudoun<br />
Zeiaei-Nafchi Saeid 000000037730 South Riding <strong>Dental</strong> Associates, P.C. 25055 Riding Plaza Dr., Suite 270 Chantilly VA 20152 General Provider Loudoun<br />
Rafaat Amirreza 000000002290 Amirreza Rafaat, D.D.S., P.C. 19450 Deerfield Avenue, Suite 465 Lansdowne VA 20176 General Provider Loudoun<br />
Lee Richard Loudoun Orthodontics 19465 Deerfield Ave, Suite 304 Lansdowne VA 20176 Orthodontist Loudoun<br />
Shojaei Mariah Mariah Shojaei, D.M.D. 46161 West Lake Drive, #120 Potomac Falls VA 20165 Endodontist Loudoun<br />
Alayssami Mazin 000000000157 Bright Now <strong>Dental</strong> 6 Pidgeon Hill Dr., Suite 200 Sterling VA 20165 General Provider Loudoun<br />
Eghtessad Mohammed 000000000157 Bright Now <strong>Dental</strong> 6 Pidgeon Hill Dr., Suite 200 Sterling VA 20165 General Provider Loudoun<br />
Nallavalli Sravanthi 000000000157 Bright Now <strong>Dental</strong> 6 Pidgeon Hill Dr., Suite 200 Sterling VA 20165 General Provider Loudoun<br />
Parvathaneni Bhavani 000000000157 Bright Now <strong>Dental</strong> 6 Pidgeon Hill Dr., Suite 200 Sterling VA 20165 General Provider Loudoun<br />
Reedy Hima-Bindu 000000000157 Bright Now <strong>Dental</strong> 6 Pidgeon Hill Dr., Suite 200 Sterling VA 20165 General Provider Loudoun<br />
Hooshmand Marie 000000001808 Marie Hooshmand, D.D.S., P.C. 21165 Whitfield Place, Suite 101 Sterling VA 20165 General Provider Loudoun<br />
Chaddad Karim Mazin Alayssami DMD & Associates PC Specialists 6 Pidgeon Hill Dr, Suite 200 Sterling VA 20165 Periodontist Loudoun<br />
Bidgoli Rashin Rashin T. Bidgoli, D.D.S. 21145 Whitfield Place, #101 Sterling VA 20165 Endodontist Loudoun<br />
Tolba Mostafa Rashin T. Bidgoli, D.D.S. 21145 Whitfield Place, #101 Sterling VA 20165 Endodontist Loudoun<br />
Duong Truc 000000001912 Truc Duong, D.D.S., PC 21145 Whitfield Pl., Suite 103 Sterling VA 20165 General Provider Loudoun<br />
Frankenberry Anishka Stone Ridge Orthodontics 24600 Millstream Drive, Suite 101 Stone Ridge VA 20105 Orthodontist Loudoun<br />
Amin Ahmad <strong>Dental</strong> One Associates Manassas PC 7800 Sudley Rd., Suite 7810 Manassas VA 20109 Oral Surgeon Manassas City<br />
Hukmani Navin <strong>Dental</strong> One Associates Manassas PC 7800 Sudley Rd., Suite 7810 Manassas VA 20109 Orthodontist Manassas City<br />
Khosravi Mitra 000000001729 <strong>Dental</strong> One Associates Manassas PC 7800 Sudley Rd., Suite 7810 Manassas VA 20109 General Provider Manassas City<br />
Rasmussen James James E. Rasmussen, D.M.D., PC 10600 Crestwood Dr. Manassas VA 20109 Oral Surgeon Manassas City<br />
Ali Ziad Manassas <strong>Dental</strong> Associates, PC Specialists 10630-B Crestwood Drive Manassas VA 20109 Oral Surgeon Manassas City<br />
Traboulsi Georges Manassas <strong>Dental</strong> Associates, PC Specialists 10630-B Crestwood Drive Manassas VA 20109 Periodontist Manassas City<br />
Sina Nadia MY BRACES DOCTOR, PC 10630 Crestwood Dr., Suite A Manassas VA 20109 Orthodontist Manassas City<br />
Biscombe Terrence 000000050778 Kevin Mendes DDS & Associates PLLC 8404 Dorsey Circle Manassas VA 20110 General Provider Manassas City<br />
Guo Juanli 000000050778 Kevin Mendes DDS & Associates PLLC 8404 Dorsey Circle Manassas VA 20110 General Provider Manassas City<br />
Huang Dan 000000050778 Kevin Mendes DDS & Associates PLLC 8404 Dorsey Circle Manassas VA 20110 General Provider Manassas City<br />
Le Tuan 000000050778 Kevin Mendes DDS & Associates PLLC 8404 Dorsey Circle Manassas VA 20110 General Provider Manassas City<br />
Lee Philip 000000050778 Kevin Mendes DDS & Associates PLLC 8404 Dorsey Circle Manassas VA 20110 General Provider Manassas City<br />
Mattern Johnson Mandy 000000050778 Kevin Mendes DDS & Associates PLLC 8404 Dorsey Circle Manassas VA 20110 General Provider Manassas City<br />
Mendes Kevin Kevin Mendes DDS & Associates PLLC 8404 Dorsey Circle Manassas VA 20110 Orthodontist Manassas City<br />
Mendes Kevin Kevin Mendes DDS & Associates PLLC 8609 Sudley Road, Suite 102 Manassas VA 20110 Orthodontist Manassas City<br />
Rejintala Archana 000000050778 Kevin Mendes DDS & Associates PLLC 8404 Dorsey Circle Manassas VA 20110 General Provider Manassas City<br />
Rusznak Zoltan 000000050778 Kevin Mendes DDS & Associates PLLC 8404 Dorsey Circle Manassas VA 20110 General Provider Manassas City<br />
Schlank Eugene 000000050778 Kevin Mendes DDS & Associates PLLC 8404 Dorsey Circle Manassas VA 20110 General Provider Manassas City<br />
Hussaini Syed Syed K Hussaini DDS 10081 Market Cir Manassas VA 20110 Orthodontist Manassas City<br />
* Chung John 000000000023 John Chung Family <strong>Dentist</strong>ry 13626 Warwick Blvd., Suite A Newport News VA 23602 General Provider Newport News City<br />
Kaplan Marvin Marvin Kaplan, D.D.S., Ltd. 13193 Warwick Boulevard Newport News VA 23602 Orthodontist Newport News City<br />
* Katz Ronald 000000002885 Warwick <strong>Dental</strong> Center 12420 Warwick Blvd., Suite 1-A Newport News VA 23606 General Provider Newport News City<br />
* Robinson Donald 000000068484 Smiles Ahead <strong>Dental</strong> 478 Denbigh Blvd Newport News VA 23608 General Provider Newport News City<br />
Hirschler David Periodontology Associates 5900 E VA Beach Blvd, 213 Janaf Office Bldg Norfolk VA 23502 Periodontist Norfolk City<br />
Witte Ernest Periodontology Associates 5900 E VA Beach Blvd, 213 Janaf Office Bldg Norfolk VA 23502 Periodontist Norfolk City<br />
Reynolds Jillian LWSS <strong>Dentist</strong>ry for Children 302 East Little Creek Road, Suite B Norfolk VA 23505 Pedodontist Norfolk City<br />
Sachs Scott LWSS <strong>Dentist</strong>ry for Children 302 East Little Creek Road, Suite B Norfolk VA 23505 Pedodontist Norfolk City<br />
Ashby John Owens and Dorfman, LTD 7400 Granby Street Norfolk VA 23505 Orthodontist Norfolk City<br />
Dailey Curtis Owens and Dorfman, LTD 7400 Granby Street Norfolk VA 23505 Orthodontist Norfolk City<br />
Esparza Sarah 000000000037 Rita Frazier, D.D.S. 136 E. Little Creek Rd. Norfolk VA 23505 General Provider Norfolk City<br />
Frazier Rita 000000000037 Rita Frazier, D.D.S. 136 E. Little Creek Rd. Norfolk VA 23505 General Provider Norfolk City<br />
Howell Robert 000000000072 Robert W. Howell, D.D.S. 110 Kingsley Lane, Suite 312 Norfolk VA 23505 General Provider Norfolk City<br />
Conelias Trent Trent P. Conelias, DDS 110 Kingsley Lane Norfolk VA 23505 Oral Surgeon Norfolk City<br />
Morrison Sanford S.Neil Morrison DDS, & Melvin R. Morrison,DDS 204 Medical Tower Norfolk VA 23507 Oral Surgeon Norfolk City<br />
Spain Murray 000000002678 Murray Spain, D.M.D. 1216 Granby St., Ste. 2 Norfolk VA 23510 General Provider Norfolk City<br />
Katz Ronald 000000002876 Tidewater <strong>Dental</strong> Center, PLLC 425 West 20th St., Suite 3 Norfolk VA 23517 General Provider Norfolk City<br />
Reynolds Kenneth 000000002876 Tidewater <strong>Dental</strong> Center, PLLC 425 West 20th St., Suite 3 Norfolk VA 23517 General Provider Norfolk City<br />
Griffin Charles 000000000098 Charles F. Griffin, D.D.S. 3277 South Crater Rd. Petersburg VA 23805 General Provider Petersburg City<br />
Jenkins Harry 000000000341 Jenkins <strong>Dental</strong> Group 3349 Portsmouth Blvd. Portsmouth VA 23701 General Provider Portsmouth City<br />
Sweeney Richard 000000051038 <strong>Dominion</strong> <strong>Dentist</strong>ry PLLC 3219 Stamford Rd Portsmouth VA 23703 General Provider Portsmouth City<br />
Martin J B Friendly Faces Pediatric <strong>Dentist</strong>ry 446 Effingham St Portsmouth VA 23704 Pedodontist Portsmouth City<br />
* Indicates dentist that is accepting current patients only.<br />
All <strong>Select</strong> <strong>Plan</strong> <strong>Dentist</strong>s Page 47<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 <strong>Dentist</strong>. Fac ID is used to indicate which facility a member chooses.
SELECT PLAN 1 DENTIST DIRECTORY<br />
<strong>Dentist</strong>s listed are under contract as of 9/1/12<br />
Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />
Green, Jr. Roosevelt 000000000073 Roosevelt T. Green, Jr.,D.D.S. 600 S. Green St. Portsmouth VA 23704 General Provider Portsmouth City<br />
Althouse Elliott 000000050822 Drs. Althouse, Carroll and Alperin 3410 County St. Portsmouth VA 23707 General Provider Portsmouth City<br />
* Reynolds Kenneth 000000002161 K. Bradley Reynolds, D.D.S. 1307 Airline Blvd. Portsmouth VA 23707 General Provider Portsmouth City<br />
Stevenson Pretlow 000000000322 Pretlow Stevenson, Jr., D.D.S. 3412 Columbia St. Portsmouth VA 23707 General Provider Portsmouth City<br />
* Hanania Hanna 000000002416 Hanna Hannania, D.D.S., P.C. 4319 Dale Blvd. Dale City VA 22193 General Provider Prince William<br />
Falaiye Victor 000000051112 The <strong>Dentist</strong> Office LLC 17865 Main St, Suite A Dumfries VA 22026 General Provider Prince William<br />
Zhu Xinsheng Zhu Orthodontics 17606 Main St., Suite 200 Dumfries VA 22026 Orthodontist Prince William<br />
Filippone Louis Louis C Filippone DDS PC 7521 Virginia Oaks Dr, Suite 120 Gainesville VA 20155 Orthodontist Prince William<br />
Ekoh Madueke Teem Orthodontics PLLC 14634 Lee Highway Gainesville VA 20155 Orthodontist Prince William<br />
Gutmann J. J. Steven Gutmann, D.D.S., P.C. 1910 Opitz Blvd. Woodbridge VA 22191 Oral Surgeon Prince William<br />
Patel Mayur 000000081562 Light Family <strong>Dental</strong> 14416 Jefferson Davis Hwy, Suite 16 Woodbridge VA 22191 General Provider Prince William<br />
Cantor David Northern Virginia Oral & Maxillofacial Surgery 2020-A Optiz Blvd., Suite A Woodbridge VA 22191 Oral Surgeon Prince William<br />
Francioni Sonia Northern Virginia Oral & Maxillofacial Surgery 2020-A Optiz Blvd., Suite A Woodbridge VA 22191 Oral Surgeon Prince William<br />
LaBriola J. Daniel Northern Virginia Oral & Maxillofacial Surgery 2020-A Optiz Blvd., Suite A Woodbridge VA 22191 Oral Surgeon Prince William<br />
Zadeh Hugh Northern Virginia Oral & Maxillofacial Surgery 2020-A Optiz Blvd., Suite A Woodbridge VA 22191 Oral Surgeon Prince William<br />
Pham Gina BriteStars Pediatric <strong>Dentist</strong>ry PLLC 12602 Lake Ridge Dr Woodbridge VA 22192 Pedodontist Prince William<br />
Frankenberry Anishka Bruce Taheri DDS PC Orthodontist 3114 Golansky Blvd., Suite 102 Woodbridge VA 22192 Orthodontist Prince William<br />
Ali Ziad Bruce Taheri, DDS, PC Specialists 3114 Golansky Blvd., #102 Woodbridge VA 22192 Oral Surgeon Prince William<br />
Traboulsi Georges Bruce Taheri, DDS, PC Specialists 3114 Golansky Blvd., #102 Woodbridge VA 22192 Periodontist Prince William<br />
Doan Thao 000000002131 <strong>Dental</strong> Center at Lake Ridge 12764 Darby Brooke Ct. Woodbridge VA 22192 General Provider Prince William<br />
Braunfeld Joel 000000000456 Joel R. Braunfeld, D.D.S. 2239-L Tackett's Mill Dr. Woodbridge VA 22192 General Provider Prince William<br />
Saleh Fadi Lake Ridge Orthodontics PC 12662 A Lake Ridge Dr, Suite A Woodbridge VA 22192 Orthodontist Prince William<br />
Pell James Oral Surgery Associates of Northern Virginia Ltd 3158 Golansky Blvd, Suite 102 Woodbridge VA 22192 Oral Surgeon Prince William<br />
Wang Richard Oral Surgery Associates of Northern Virginia Ltd 3158 Golansky Blvd, Suite 102 Woodbridge VA 22192 Oral Surgeon Prince William<br />
Le Kathy Sameer Kwatra DDS PC Specialists 2970 Prince William Pwky Woodbridge VA 22192 Endodontist Prince William<br />
Colina Kevin 000000033879 Sameer Kwatra, D.D.S., PC 2970 Prince William Pkwy Woodbridge VA 22192 General Provider Prince William<br />
Dulabh Mita 000000033879 Sameer Kwatra, D.D.S., PC 2970 Prince William Pkwy Woodbridge VA 22192 General Provider Prince William<br />
Kwatra Sameer 000000033879 Sameer Kwatra, D.D.S., PC 2970 Prince William Pkwy Woodbridge VA 22192 General Provider Prince William<br />
Amin Ahmad Woodbridge <strong>Dental</strong> Associates P.C. 14520 Smoketown Rd. Woodbridge VA 22192 Oral Surgeon Prince William<br />
Hukmani Navin Woodbridge <strong>Dental</strong> Associates P.C. 14520 Smoketown Rd. Woodbridge VA 22192 Orthodontist Prince William<br />
Valleru Silvija 000000001731 Woodbridge <strong>Dental</strong> Associates P.C. 14520 Smoketown Rd. Woodbridge VA 22192 General Provider Prince William<br />
Zeiaei-Nafchi Saeid 000000001731 Woodbridge <strong>Dental</strong> Associates P.C. 14520 Smoketown Rd. Woodbridge VA 22192 General Provider Prince William<br />
Nguyen Phuong Woodbridge Oral and Maxillofacial Surgery Center 4585 Daisy Reid Avenue, Suite 105 Woodbridge VA 22192 Oral Surgeon Prince William<br />
* Haston Raymond 000000000451 Raymond C. Haston, Jr., D.D.S. 14393 Hereford Road Woodbridge VA 22193 General Provider Prince William<br />
Morrison Julius 000000000059 Julius V. Morrison, D.D.S. 530 E Main St., Suite 400 Richmond VA 23219 General Provider Richmond City<br />
Exum Antone 000000079793 Antone Exum DDS 505 W Leight Street, Suite 106 Richmond VA 23220 General Provider Richmond City<br />
Adams Randy <strong>Dentist</strong>ry for Children 300 W. Broad Street Richmond VA 23220 Pedodontist Richmond City<br />
* Jones John 000000000064 John W. Jones, D.D.S. 1805 Monument Ave., Suite 501 Richmond VA 23220 General Provider Richmond City<br />
English, II Sam 000000002669 Sam E English II DDS LLC 3500 Grove Ave. Richmond VA 23221 General Provider Richmond City<br />
Musetti Christopher 000000002669 Sam E English II DDS LLC 3500 Grove Ave. Richmond VA 23221 General Provider Richmond City<br />
Roberts Cameron 000000002669 Sam E English II DDS LLC 3500 Grove Ave. Richmond VA 23221 General Provider Richmond City<br />
Grantham Tabbitha 000000038060 Grantham Family <strong>Dentist</strong>ry 1122 N 25th St, Suite E Richmond VA 23223 General Provider Richmond City<br />
Morrison Julius 000000001930 Vernon J. Harris East End Community Health Center 719 N. 25th St., 2nd Floor Richmond VA 23223 General Provider Richmond City<br />
Byrd Richard Richard L. Byrd, D.D.S. 101 Cowardin Ave., #306-A Richmond VA 23224 Orthodontist Richmond City<br />
Cade Ronald Ronald E. Cade, <strong>Inc</strong>. 101 Cowardin Avenue, Suite 206 Richmond VA 23224 Prosthodontist Richmond City<br />
* Puller Anthony 000000000010 Anthony J Puller DDS 7834 Forest Hill Ave., Suite 6 Richmond VA 23225 General Provider Richmond City<br />
Lilly, Jr. J. David 000000000012 J David Lilly Jr DDS 7834 Forest Hill Avenue Richmond VA 23225 General Provider Richmond City<br />
Byrd Richard Richard L. Byrd, D.D.S., Ltd. 6740 Forest Hill Avenue, Suite 103 Richmond VA 23225 Orthodontist Richmond City<br />
Abubaker A Omar <strong>Dentist</strong>ry@VCU 521 North 11th Street, P.O. Box 980566 Richmond VA 23298 Oral Surgeon Richmond City<br />
DeLuke Dean <strong>Dentist</strong>ry@VCU 521 North 11th Street, P.O. Box 980566 Richmond VA 23298 Oral Surgeon Richmond City<br />
Desai Bhavik <strong>Dentist</strong>ry@VCU 521 North 11th Street, P.O. Box 980566 Richmond VA 23298 Oral Surgeon Richmond City<br />
Giglio James <strong>Dentist</strong>ry@VCU 521 North 11th Street, P.O. Box 980566 Richmond VA 23298 Oral Surgeon Richmond City<br />
Laskin Daniel <strong>Dentist</strong>ry@VCU 521 North 11th Street, P.O. Box 980566 Richmond VA 23298 Oral Surgeon Richmond City<br />
Smagalski Gary <strong>Dentist</strong>ry@VCU 521 North 11th Street, P.O. Box 980566 Richmond VA 23298 Oral Surgeon Richmond City<br />
Strauss Robert <strong>Dentist</strong>ry@VCU 521 North 11th Street, P.O. Box 980566 Richmond VA 23298 Oral Surgeon Richmond City<br />
Terrill David David Terrill, D.D.S. 11113 Leavells Rd. Fredericksburg VA 22407 Orthodontist Spotsylvania<br />
Romano Frank 000000000147 Frank D. Romano, D.D.S. 1133 Heatherstone Dr. Fredericksburg VA 22407 General Provider Spotsylvania<br />
Byrd Richard Fredericksburg Pediatric <strong>Dentist</strong>ry 927 Maple Grove Drive, Suite 111 Fredericksburg VA 22407 Orthodontist Spotsylvania<br />
Sina Nadia MY BRACES DOCTOR, PC 4300 <strong>Plan</strong>k Rd., Suite 230 Fredericksburg VA 22407 Orthodontist Spotsylvania<br />
Pagan Robert R. David Pagan, D.M.D., P.C. 4224 <strong>Plan</strong>k Rd., Ste.B Fredericksburg VA 22407 Endodontist Spotsylvania<br />
Abuhajleh Omar 000000037958 Bright Now <strong>Dental</strong> 10454 Hill Top Plaza Way Spotsylvania VA 22553 General Provider Spotsylvania<br />
Alayssami Mazin 000000037958 Bright Now <strong>Dental</strong> 10454 Hill Top Plaza Way Spotsylvania VA 22553 General Provider Spotsylvania<br />
Byrd Richard Bright Now <strong>Dental</strong> 10454 Hill Top Plaza Way Spotsylvania VA 22553 Orthodontist Spotsylvania<br />
Khalaf Athra 000000037958 Bright Now <strong>Dental</strong> 10454 Hill Top Plaza Way Spotsylvania VA 22553 General Provider Spotsylvania<br />
Malghan Nandini 000000037958 Bright Now <strong>Dental</strong> 10454 Hill Top Plaza Way Spotsylvania VA 22553 General Provider Spotsylvania<br />
Coker John John H Coker Jr DMD 10472 Georgetown Drive Spotsylvania VA 22553 Orthodontist Spotsylvania<br />
* Indicates dentist that is accepting current patients only.<br />
All <strong>Select</strong> <strong>Plan</strong> <strong>Dentist</strong>s Page 48<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 <strong>Dentist</strong>. Fac ID is used to indicate which facility a member chooses.
SELECT PLAN 1 DENTIST DIRECTORY<br />
<strong>Dentist</strong>s listed are under contract as of 9/1/12<br />
Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />
* Haston Raymond 000000000428 Raymond C Haston Jr DDS PC 560 Celebrate Virginia Pkwy, 107 Fredericksburg VA 22406 General Provider Stafford<br />
Alayssami Mazin 000000000156 Bright Now <strong>Dental</strong> 392 Garrisonville Rd., Suite 205 Stafford VA 22554 General Provider Stafford<br />
Byrd Richard Bright Now <strong>Dental</strong> 392 Garrisonville Rd., Suite 205 Stafford VA 22554 Orthodontist Stafford<br />
Elgazzar Mohamed 000000000156 Bright Now <strong>Dental</strong> 392 Garrisonville Rd., Suite 205 Stafford VA 22554 General Provider Stafford<br />
Niepraschk Markus Bright Now <strong>Dental</strong> 392 Garrisonville Rd., Suite 205 Stafford VA 22554 Orthodontist Stafford<br />
Palle Sunitha 000000000156 Bright Now <strong>Dental</strong> 392 Garrisonville Rd., Suite 205 Stafford VA 22554 General Provider Stafford<br />
* Attreed Elizabeth 000000000854 Elizabeth M Attreed DDS 2832 Jefferson Davis Hwy, Aquia Towne Center Stafford VA 22554 General Provider Stafford<br />
Coker John John H Coker Jr DMD 239 Garrisonville Rd., Suite 101 Stafford VA 22554 Orthodontist Stafford<br />
Chaddad Karim Mazin Alayssami DMD & Associates PC Specialists 392 Garrisonville Rd, Suite 205 Stafford VA 22554 Periodontist Stafford<br />
Patel Ashish Mazin Alayssami DMD & Associates PC Specialists 392 Garrisonville Rd, Suite 205 Stafford VA 22554 Oral Surgeon Stafford<br />
* Abdelwahab Tamer 000000050724 Konikoff <strong>Dental</strong> Associates 5849 Harbour View Blvd, Suite 100 Suffolk VA 23435 General Provider Suffolk City<br />
* Ansari Uzma 000000050724 Konikoff <strong>Dental</strong> Associates 5849 Harbour View Blvd, Suite 100 Suffolk VA 23435 General Provider Suffolk City<br />
* Berrada Sanae 000000050724 Konikoff <strong>Dental</strong> Associates 5849 Harbour View Blvd, Suite 100 Suffolk VA 23435 General Provider Suffolk City<br />
* Bozman Jenny 000000050724 Konikoff <strong>Dental</strong> Associates 5849 Harbour View Blvd, Suite 100 Suffolk VA 23435 General Provider Suffolk City<br />
* Chawla Seema 000000050724 Konikoff <strong>Dental</strong> Associates 5849 Harbour View Blvd, Suite 100 Suffolk VA 23435 General Provider Suffolk City<br />
* Dobson Roberta 000000050724 Konikoff <strong>Dental</strong> Associates 5849 Harbour View Blvd, Suite 100 Suffolk VA 23435 General Provider Suffolk City<br />
* Dobson, III Joseph 000000050724 Konikoff <strong>Dental</strong> Associates 5849 Harbour View Blvd, Suite 100 Suffolk VA 23435 General Provider Suffolk City<br />
* Elosta Wael 000000050724 Konikoff <strong>Dental</strong> Associates 5849 Harbour View Blvd, Suite 100 Suffolk VA 23435 General Provider Suffolk City<br />
* Field Marcus 000000050724 Konikoff <strong>Dental</strong> Associates 5849 Harbour View Blvd, Suite 100 Suffolk VA 23435 General Provider Suffolk City<br />
* Field Sheila 000000050724 Konikoff <strong>Dental</strong> Associates 5849 Harbour View Blvd, Suite 100 Suffolk VA 23435 General Provider Suffolk City<br />
* Gioffre Mollie 000000050724 Konikoff <strong>Dental</strong> Associates 5849 Harbour View Blvd, Suite 100 Suffolk VA 23435 General Provider Suffolk City<br />
* Hoek Meredith 000000050724 Konikoff <strong>Dental</strong> Associates 5849 Harbour View Blvd, Suite 100 Suffolk VA 23435 General Provider Suffolk City<br />
* Jones Daniel 000000050724 Konikoff <strong>Dental</strong> Associates 5849 Harbour View Blvd, Suite 100 Suffolk VA 23435 General Provider Suffolk City<br />
* Konikoff David 000000050724 Konikoff <strong>Dental</strong> Associates 5849 Harbour View Blvd, Suite 100 Suffolk VA 23435 General Provider Suffolk City<br />
* Lanigan Jacqueline 000000050724 Konikoff <strong>Dental</strong> Associates 5849 Harbour View Blvd, Suite 100 Suffolk VA 23435 General Provider Suffolk City<br />
* Maclin Ivetta 000000050724 Konikoff <strong>Dental</strong> Associates 5849 Harbour View Blvd, Suite 100 Suffolk VA 23435 General Provider Suffolk City<br />
* Mady Zeyad 000000050724 Konikoff <strong>Dental</strong> Associates 5849 Harbour View Blvd, Suite 100 Suffolk VA 23435 General Provider Suffolk City<br />
* Maniwang Jo-Marie 000000050724 Konikoff <strong>Dental</strong> Associates 5849 Harbour View Blvd, Suite 100 Suffolk VA 23435 General Provider Suffolk City<br />
* Mattioli Michele 000000050724 Konikoff <strong>Dental</strong> Associates 5849 Harbour View Blvd, Suite 100 Suffolk VA 23435 General Provider Suffolk City<br />
* McCarty Benjamin 000000050724 Konikoff <strong>Dental</strong> Associates 5849 Harbour View Blvd, Suite 100 Suffolk VA 23435 General Provider Suffolk City<br />
* Miranda Joshua 000000050724 Konikoff <strong>Dental</strong> Associates 5849 Harbour View Blvd, Suite 100 Suffolk VA 23435 General Provider Suffolk City<br />
* Morris Mason-Leigh 000000050724 Konikoff <strong>Dental</strong> Associates 5849 Harbour View Blvd, Suite 100 Suffolk VA 23435 General Provider Suffolk City<br />
* Muldoon Catherine 000000050724 Konikoff <strong>Dental</strong> Associates 5849 Harbour View Blvd, Suite 100 Suffolk VA 23435 General Provider Suffolk City<br />
* Parker Richard 000000050724 Konikoff <strong>Dental</strong> Associates 5849 Harbour View Blvd, Suite 100 Suffolk VA 23435 General Provider Suffolk City<br />
* Pearl Dina 000000050724 Konikoff <strong>Dental</strong> Associates 5849 Harbour View Blvd, Suite 100 Suffolk VA 23435 General Provider Suffolk City<br />
* Reichley John 000000050724 Konikoff <strong>Dental</strong> Associates 5849 Harbour View Blvd, Suite 100 Suffolk VA 23435 General Provider Suffolk City<br />
* Richards Damdy 000000050724 Konikoff <strong>Dental</strong> Associates 5849 Harbour View Blvd, Suite 100 Suffolk VA 23435 General Provider Suffolk City<br />
* Santos Estelito 000000050724 Konikoff <strong>Dental</strong> Associates 5849 Harbour View Blvd, Suite 100 Suffolk VA 23435 General Provider Suffolk City<br />
* Solarte-Castro Edith 000000050724 Konikoff <strong>Dental</strong> Associates 5849 Harbour View Blvd, Suite 100 Suffolk VA 23435 General Provider Suffolk City<br />
* Tam Amy 000000050724 Konikoff <strong>Dental</strong> Associates 5849 Harbour View Blvd, Suite 100 Suffolk VA 23435 General Provider Suffolk City<br />
* Throckmorton Maria 000000050724 Konikoff <strong>Dental</strong> Associates 5849 Harbour View Blvd, Suite 100 Suffolk VA 23435 General Provider Suffolk City<br />
Reynolds Jillian LWSS <strong>Dentist</strong>ry for Children 210 Meadow View Blvd Suffolk VA 23435 Pedodontist Suffolk City<br />
Sachs Scott LWSS <strong>Dentist</strong>ry for Children 210 Meadow View Blvd Suffolk VA 23435 Pedodontist Suffolk City<br />
Byrnside Valerie Scott R Goodove DDS PLC 5849 Harbour View Blvd, Suite 120 Suffolk VA 23435 Oral Surgeon Suffolk City<br />
Goodove Scott Scott R Goodove DDS PLC 5849 Harbour View Blvd, Suite 120 Suffolk VA 23435 Oral Surgeon Suffolk City<br />
Harris Christopher Scott R Goodove DDS PLC 5849 Harbour View Blvd, Suite 120 Suffolk VA 23435 Oral Surgeon Suffolk City<br />
Ellis Kevin 000000061307 Advanced Sedation <strong>Dentist</strong>ry 616 Virginia Beach Blvd, Suite 102 Virginia Beach VA 23451 General Provider Virginia Beach City<br />
Futerman Len 000000061307 Advanced Sedation <strong>Dentist</strong>ry 616 Virginia Beach Blvd, Suite 102 Virginia Beach VA 23451 General Provider Virginia Beach City<br />
Oduyelu Bukola Advanced Sedation <strong>Dentist</strong>ry Specialists 616 Virginia Beach Blvd, Suite 102 Virginia Beach VA 23451 Pedodontist Virginia Beach City<br />
Ellis Kevin 000000001692 Kevin J. Ellis, D.M.D. Family <strong>Dentist</strong>ry 205 34th Street, Suite 112 Virginia Beach VA 23451 General Provider Virginia Beach City<br />
* Abdelwahab Tamer 000000050723 Konikoff <strong>Dental</strong> Associates 2829 Shore Dr, Suite 100 Virginia Beach VA 23451 General Provider Virginia Beach City<br />
* Ansari Uzma 000000050723 Konikoff <strong>Dental</strong> Associates 2829 Shore Dr, Suite 100 Virginia Beach VA 23451 General Provider Virginia Beach City<br />
* Berrada Sanae 000000050723 Konikoff <strong>Dental</strong> Associates 2829 Shore Dr, Suite 100 Virginia Beach VA 23451 General Provider Virginia Beach City<br />
* Bozman Jenny 000000050723 Konikoff <strong>Dental</strong> Associates 2829 Shore Dr, Suite 100 Virginia Beach VA 23451 General Provider Virginia Beach City<br />
* Chawla Seema 000000050723 Konikoff <strong>Dental</strong> Associates 2829 Shore Dr, Suite 100 Virginia Beach VA 23451 General Provider Virginia Beach City<br />
* Dobson Roberta 000000050723 Konikoff <strong>Dental</strong> Associates 2829 Shore Dr, Suite 100 Virginia Beach VA 23451 General Provider Virginia Beach City<br />
* Dobson, III Joseph 000000050723 Konikoff <strong>Dental</strong> Associates 2829 Shore Dr, Suite 100 Virginia Beach VA 23451 General Provider Virginia Beach City<br />
* Elosta Wael 000000050723 Konikoff <strong>Dental</strong> Associates 2829 Shore Dr, Suite 100 Virginia Beach VA 23451 General Provider Virginia Beach City<br />
* Field Marcus 000000050723 Konikoff <strong>Dental</strong> Associates 2829 Shore Dr, Suite 100 Virginia Beach VA 23451 General Provider Virginia Beach City<br />
* Field Sheila 000000050723 Konikoff <strong>Dental</strong> Associates 2829 Shore Dr, Suite 100 Virginia Beach VA 23451 General Provider Virginia Beach City<br />
* Gioffre Mollie 000000050723 Konikoff <strong>Dental</strong> Associates 2829 Shore Dr, Suite 100 Virginia Beach VA 23451 General Provider Virginia Beach City<br />
* Hoek Meredith 000000050723 Konikoff <strong>Dental</strong> Associates 2829 Shore Dr, Suite 100 Virginia Beach VA 23451 General Provider Virginia Beach City<br />
* Jones Daniel 000000050723 Konikoff <strong>Dental</strong> Associates 2829 Shore Dr, Suite 100 Virginia Beach VA 23451 General Provider Virginia Beach City<br />
* Konikoff David 000000050723 Konikoff <strong>Dental</strong> Associates 2829 Shore Dr, Suite 100 Virginia Beach VA 23451 General Provider Virginia Beach City<br />
* Lanigan Jacqueline 000000050723 Konikoff <strong>Dental</strong> Associates 2829 Shore Dr, Suite 100 Virginia Beach VA 23451 General Provider Virginia Beach City<br />
* Maclin Ivetta 000000050723 Konikoff <strong>Dental</strong> Associates 2829 Shore Dr, Suite 100 Virginia Beach VA 23451 General Provider Virginia Beach City<br />
* Indicates dentist that is accepting current patients only.<br />
All <strong>Select</strong> <strong>Plan</strong> <strong>Dentist</strong>s Page 49<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 <strong>Dentist</strong>. Fac ID is used to indicate which facility a member chooses.
SELECT PLAN 1 DENTIST DIRECTORY<br />
<strong>Dentist</strong>s listed are under contract as of 9/1/12<br />
Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />
* Mady Zeyad 000000050723 Konikoff <strong>Dental</strong> Associates 2829 Shore Dr, Suite 100 Virginia Beach VA 23451 General Provider Virginia Beach City<br />
* Maniwang Jo-Marie 000000050723 Konikoff <strong>Dental</strong> Associates 2829 Shore Dr, Suite 100 Virginia Beach VA 23451 General Provider Virginia Beach City<br />
* Mattioli Michele 000000050723 Konikoff <strong>Dental</strong> Associates 2829 Shore Dr, Suite 100 Virginia Beach VA 23451 General Provider Virginia Beach City<br />
* McCarty Benjamin 000000050723 Konikoff <strong>Dental</strong> Associates 2829 Shore Dr, Suite 100 Virginia Beach VA 23451 General Provider Virginia Beach City<br />
* Miranda Joshua 000000050723 Konikoff <strong>Dental</strong> Associates 2829 Shore Dr, Suite 100 Virginia Beach VA 23451 General Provider Virginia Beach City<br />
* Morris Mason-Leigh 000000050723 Konikoff <strong>Dental</strong> Associates 2829 Shore Dr, Suite 100 Virginia Beach VA 23451 General Provider Virginia Beach City<br />
* Muldoon Catherine 000000050723 Konikoff <strong>Dental</strong> Associates 2829 Shore Dr, Suite 100 Virginia Beach VA 23451 General Provider Virginia Beach City<br />
* Parker Richard 000000050723 Konikoff <strong>Dental</strong> Associates 2829 Shore Dr, Suite 100 Virginia Beach VA 23451 General Provider Virginia Beach City<br />
* Pearl Dina 000000050723 Konikoff <strong>Dental</strong> Associates 2829 Shore Dr, Suite 100 Virginia Beach VA 23451 General Provider Virginia Beach City<br />
* Reichley John 000000050723 Konikoff <strong>Dental</strong> Associates 2829 Shore Dr, Suite 100 Virginia Beach VA 23451 General Provider Virginia Beach City<br />
* Richards Damdy 000000050723 Konikoff <strong>Dental</strong> Associates 2829 Shore Dr, Suite 100 Virginia Beach VA 23451 General Provider Virginia Beach City<br />
* Santos Estelito 000000050723 Konikoff <strong>Dental</strong> Associates 2829 Shore Dr, Suite 100 Virginia Beach VA 23451 General Provider Virginia Beach City<br />
* Solarte-Castro Edith 000000050723 Konikoff <strong>Dental</strong> Associates 2829 Shore Dr, Suite 100 Virginia Beach VA 23451 General Provider Virginia Beach City<br />
* Tam Amy 000000050723 Konikoff <strong>Dental</strong> Associates 2829 Shore Dr, Suite 100 Virginia Beach VA 23451 General Provider Virginia Beach City<br />
* Throckmorton Maria 000000050723 Konikoff <strong>Dental</strong> Associates 2829 Shore Dr, Suite 100 Virginia Beach VA 23451 General Provider Virginia Beach City<br />
Hartman Gary Gary A. Hartman, D.D.S., MS. Ltd 240 Mustang Tr Virginia Beach VA 23452 Periodontist Virginia Beach City<br />
Konikoff Albert Konikoff Periodontics, Ltd. 477 Viking Drive, #190 Virginia Beach VA 23452 Periodontist Virginia Beach City<br />
Folck Michael Mid Atlantic Implant and Oral Surgery Center, PC 272 Bendix Road, Suite 280 Virginia Beach VA 23452 Oral Surgeon Virginia Beach City<br />
Spain Murray 000000000097 Murray Spain, D.M.D. 3634 S. Plaza Trail #101 Virginia Beach VA 23452 General Provider Virginia Beach City<br />
Ashby John Owens and Dorfman, Ltd. 4356-4 Bonney Rd., #101 Virginia Beach VA 23452 Orthodontist Virginia Beach City<br />
Dailey Curtis Owens and Dorfman, Ltd. 4356-4 Bonney Rd., #101 Virginia Beach VA 23452 Orthodontist Virginia Beach City<br />
Nido Arthur 000000000076 Arthur Nido, D.M.D. 525 N. Great Neck Road Virginia Beach VA 23454 General Provider Virginia Beach City<br />
Ford Melvin Drs. Ford, Guter & Rai 933 First Colonial Road, Suite 205 Virginia Beach VA 23454 Oral Surgeon Virginia Beach City<br />
Guter Klaus Drs. Ford, Guter & Rai 933 First Colonial Road, Suite 205 Virginia Beach VA 23454 Oral Surgeon Virginia Beach City<br />
Rai Shaun Drs. Ford, Guter & Rai 933 First Colonial Road, Suite 205 Virginia Beach VA 23454 Oral Surgeon Virginia Beach City<br />
Elattrache Dean General Booth Endodontics, L.L.C. 2020 General Booth Blvd., Suite 100 Virginia Beach VA 23454 Endodontist Virginia Beach City<br />
Leidy Jeffrey 000000000080 Jeffrey R. Leidy, D.M.D., P.C. 1301 First Colonial Rd. Virginia Beach VA 23454 General Provider Virginia Beach City<br />
Shulman Jeremy Jeremy Shulman, D.D.S., MS 1301 First Colonial Road Virginia Beach VA 23454 Periodontist Virginia Beach City<br />
Reynolds Jillian LWSS <strong>Dentist</strong>ry for Children 1157 First Colonial Rd Virginia Beach VA 23454 Pedodontist Virginia Beach City<br />
Sachs Scott LWSS <strong>Dentist</strong>ry for Children 1157 First Colonial Rd Virginia Beach VA 23454 Pedodontist Virginia Beach City<br />
Quigg Richard Richard K. Quigg, D.D.S. 984 First Colonial Rd., Ste. 300 Virginia Beach VA 23454 Oral Surgeon Virginia Beach City<br />
Byrnside Valerie Scott R. Goodove, D.D.S., PLC 1127 First Colonial Rd. Virginia Beach VA 23454 Oral Surgeon Virginia Beach City<br />
Goodove Scott Scott R. Goodove, D.D.S., PLC 1127 First Colonial Rd. Virginia Beach VA 23454 Oral Surgeon Virginia Beach City<br />
Harris Christopher Scott R. Goodove, D.D.S., PLC 1127 First Colonial Rd. Virginia Beach VA 23454 Oral Surgeon Virginia Beach City<br />
Berger Arnold 000000000027 The Doctors Berger DMD PLC 2404 Virginia Beach Blvd., Suite 106 Virginia Beach VA 23454 General Provider Virginia Beach City<br />
Berger Louis 000000000027 The Doctors Berger DMD PLC 2404 Virginia Beach Blvd., Suite 106 Virginia Beach VA 23454 General Provider Virginia Beach City<br />
Vendetti Curtis Virginia Surgical Arts, LLC 1240 Perimeter Parkway, Suite 401 Virginia Beach VA 23454 Oral Surgeon Virginia Beach City<br />
Spain Murray 000000002863 Murray Spain, Jr., D.M.D. 1127 Independence Blvd. Virginia Beach VA 23455 General Provider Virginia Beach City<br />
Mahanes Alan 000000000543 Alan Mahanes, D.D.S. 2521 North Landing Rd, 100 Virginia Beach VA 23456 General Provider Virginia Beach City<br />
Oduyelu Bukola Bukola A. Oduyelu, D.D.S., P.C. 2264 London Bridge Rd, Suite 105 Virginia Beach VA 23456 Pedodontist Virginia Beach City<br />
Ford Melvin Drs. Ford, Guter & Rai 2100 Lynnhaven Pkwy, Suite 102 Virginia Beach VA 23456 Oral Surgeon Virginia Beach City<br />
Guter Klaus Drs. Ford, Guter & Rai 2100 Lynnhaven Pkwy, Suite 102 Virginia Beach VA 23456 Oral Surgeon Virginia Beach City<br />
Rai Shaun Drs. Ford, Guter & Rai 2100 Lynnhaven Pkwy, Suite 102 Virginia Beach VA 23456 Oral Surgeon Virginia Beach City<br />
* Abdelwahab Tamer 000000050719 Konikoff <strong>Dental</strong> Associates 2100 Lynnhaven Pkwy, Suite 100 Virginia Beach VA 23456 General Provider Virginia Beach City<br />
* Abdelwahab Tamer 000000050720 Konikoff <strong>Dental</strong> Associates 2301 A General Booth Blvd Virginia Beach VA 23456 General Provider Virginia Beach City<br />
* Ansari Uzma 000000050719 Konikoff <strong>Dental</strong> Associates 2100 Lynnhaven Pkwy, Suite 100 Virginia Beach VA 23456 General Provider Virginia Beach City<br />
* Ansari Uzma 000000050720 Konikoff <strong>Dental</strong> Associates 2301 A General Booth Blvd Virginia Beach VA 23456 General Provider Virginia Beach City<br />
* Berrada Sanae 000000050719 Konikoff <strong>Dental</strong> Associates 2100 Lynnhaven Pkwy, Suite 100 Virginia Beach VA 23456 General Provider Virginia Beach City<br />
* Berrada Sanae 000000050720 Konikoff <strong>Dental</strong> Associates 2301 A General Booth Blvd Virginia Beach VA 23456 General Provider Virginia Beach City<br />
* Bozman Jenny 000000050719 Konikoff <strong>Dental</strong> Associates 2100 Lynnhaven Pkwy, Suite 100 Virginia Beach VA 23456 General Provider Virginia Beach City<br />
* Bozman Jenny 000000050720 Konikoff <strong>Dental</strong> Associates 2301 A General Booth Blvd Virginia Beach VA 23456 General Provider Virginia Beach City<br />
* Chawla Seema 000000050719 Konikoff <strong>Dental</strong> Associates 2100 Lynnhaven Pkwy, Suite 100 Virginia Beach VA 23456 General Provider Virginia Beach City<br />
* Chawla Seema 000000050720 Konikoff <strong>Dental</strong> Associates 2301 A General Booth Blvd Virginia Beach VA 23456 General Provider Virginia Beach City<br />
* Dobson Roberta 000000050719 Konikoff <strong>Dental</strong> Associates 2100 Lynnhaven Pkwy, Suite 100 Virginia Beach VA 23456 General Provider Virginia Beach City<br />
* Dobson Roberta 000000050720 Konikoff <strong>Dental</strong> Associates 2301 A General Booth Blvd Virginia Beach VA 23456 General Provider Virginia Beach City<br />
* Dobson, III Joseph 000000050719 Konikoff <strong>Dental</strong> Associates 2100 Lynnhaven Pkwy, Suite 100 Virginia Beach VA 23456 General Provider Virginia Beach City<br />
* Dobson, III Joseph 000000050720 Konikoff <strong>Dental</strong> Associates 2301 A General Booth Blvd Virginia Beach VA 23456 General Provider Virginia Beach City<br />
* Elosta Wael 000000050719 Konikoff <strong>Dental</strong> Associates 2100 Lynnhaven Pkwy, Suite 100 Virginia Beach VA 23456 General Provider Virginia Beach City<br />
* Elosta Wael 000000050720 Konikoff <strong>Dental</strong> Associates 2301 A General Booth Blvd Virginia Beach VA 23456 General Provider Virginia Beach City<br />
* Field Marcus 000000050719 Konikoff <strong>Dental</strong> Associates 2100 Lynnhaven Pkwy, Suite 100 Virginia Beach VA 23456 General Provider Virginia Beach City<br />
* Field Marcus 000000050720 Konikoff <strong>Dental</strong> Associates 2301 A General Booth Blvd Virginia Beach VA 23456 General Provider Virginia Beach City<br />
* Field Sheila 000000050719 Konikoff <strong>Dental</strong> Associates 2100 Lynnhaven Pkwy, Suite 100 Virginia Beach VA 23456 General Provider Virginia Beach City<br />
* Field Sheila 000000050720 Konikoff <strong>Dental</strong> Associates 2301 A General Booth Blvd Virginia Beach VA 23456 General Provider Virginia Beach City<br />
* Gioffre Mollie 000000050719 Konikoff <strong>Dental</strong> Associates 2100 Lynnhaven Pkwy, Suite 100 Virginia Beach VA 23456 General Provider Virginia Beach City<br />
* Gioffre Mollie 000000050720 Konikoff <strong>Dental</strong> Associates 2301 A General Booth Blvd Virginia Beach VA 23456 General Provider Virginia Beach City<br />
* Hoek Meredith 000000050719 Konikoff <strong>Dental</strong> Associates 2100 Lynnhaven Pkwy, Suite 100 Virginia Beach VA 23456 General Provider Virginia Beach City<br />
* Indicates dentist that is accepting current patients only.<br />
All <strong>Select</strong> <strong>Plan</strong> <strong>Dentist</strong>s Page 50<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 <strong>Dentist</strong>. Fac ID is used to indicate which facility a member chooses.
SELECT PLAN 1 DENTIST DIRECTORY<br />
<strong>Dentist</strong>s listed are under contract as of 9/1/12<br />
Last Name First Name Fac ID <strong>Dental</strong> Office Name Office Address City ST ZIP Discipline County<br />
* Hoek Meredith 000000050720 Konikoff <strong>Dental</strong> Associates 2301 A General Booth Blvd Virginia Beach VA 23456 General Provider Virginia Beach City<br />
* Jones Daniel 000000050719 Konikoff <strong>Dental</strong> Associates 2100 Lynnhaven Pkwy, Suite 100 Virginia Beach VA 23456 General Provider Virginia Beach City<br />
* Jones Daniel 000000050720 Konikoff <strong>Dental</strong> Associates 2301 A General Booth Blvd Virginia Beach VA 23456 General Provider Virginia Beach City<br />
* Konikoff David 000000050719 Konikoff <strong>Dental</strong> Associates 2100 Lynnhaven Pkwy, Suite 100 Virginia Beach VA 23456 General Provider Virginia Beach City<br />
* Konikoff David 000000050720 Konikoff <strong>Dental</strong> Associates 2301 A General Booth Blvd Virginia Beach VA 23456 General Provider Virginia Beach City<br />
* Lanigan Jacqueline 000000050719 Konikoff <strong>Dental</strong> Associates 2100 Lynnhaven Pkwy, Suite 100 Virginia Beach VA 23456 General Provider Virginia Beach City<br />
* Lanigan Jacqueline 000000050720 Konikoff <strong>Dental</strong> Associates 2301 A General Booth Blvd Virginia Beach VA 23456 General Provider Virginia Beach City<br />
* Maclin Ivetta 000000050719 Konikoff <strong>Dental</strong> Associates 2100 Lynnhaven Pkwy, Suite 100 Virginia Beach VA 23456 General Provider Virginia Beach City<br />
* Maclin Ivetta 000000050720 Konikoff <strong>Dental</strong> Associates 2301 A General Booth Blvd Virginia Beach VA 23456 General Provider Virginia Beach City<br />
* Mady Zeyad 000000050719 Konikoff <strong>Dental</strong> Associates 2100 Lynnhaven Pkwy, Suite 100 Virginia Beach VA 23456 General Provider Virginia Beach City<br />
* Mady Zeyad 000000050720 Konikoff <strong>Dental</strong> Associates 2301 A General Booth Blvd Virginia Beach VA 23456 General Provider Virginia Beach City<br />
* Maniwang Jo-Marie 000000050719 Konikoff <strong>Dental</strong> Associates 2100 Lynnhaven Pkwy, Suite 100 Virginia Beach VA 23456 General Provider Virginia Beach City<br />
* Maniwang Jo-Marie 000000050720 Konikoff <strong>Dental</strong> Associates 2301 A General Booth Blvd Virginia Beach VA 23456 General Provider Virginia Beach City<br />
* Mattioli Michele 000000050719 Konikoff <strong>Dental</strong> Associates 2100 Lynnhaven Pkwy, Suite 100 Virginia Beach VA 23456 General Provider Virginia Beach City<br />
* Mattioli Michele 000000050720 Konikoff <strong>Dental</strong> Associates 2301 A General Booth Blvd Virginia Beach VA 23456 General Provider Virginia Beach City<br />
* McCarty Benjamin 000000050719 Konikoff <strong>Dental</strong> Associates 2100 Lynnhaven Pkwy, Suite 100 Virginia Beach VA 23456 General Provider Virginia Beach City<br />
* McCarty Benjamin 000000050720 Konikoff <strong>Dental</strong> Associates 2301 A General Booth Blvd Virginia Beach VA 23456 General Provider Virginia Beach City<br />
* Miranda Joshua 000000050719 Konikoff <strong>Dental</strong> Associates 2100 Lynnhaven Pkwy, Suite 100 Virginia Beach VA 23456 General Provider Virginia Beach City<br />
* Miranda Joshua 000000050720 Konikoff <strong>Dental</strong> Associates 2301 A General Booth Blvd Virginia Beach VA 23456 General Provider Virginia Beach City<br />
* Morris Mason-Leigh 000000050719 Konikoff <strong>Dental</strong> Associates 2100 Lynnhaven Pkwy, Suite 100 Virginia Beach VA 23456 General Provider Virginia Beach City<br />
* Morris Mason-Leigh 000000050720 Konikoff <strong>Dental</strong> Associates 2301 A General Booth Blvd Virginia Beach VA 23456 General Provider Virginia Beach City<br />
* Muldoon Catherine 000000050719 Konikoff <strong>Dental</strong> Associates 2100 Lynnhaven Pkwy, Suite 100 Virginia Beach VA 23456 General Provider Virginia Beach City<br />
* Muldoon Catherine 000000050720 Konikoff <strong>Dental</strong> Associates 2301 A General Booth Blvd Virginia Beach VA 23456 General Provider Virginia Beach City<br />
* Newman Michael 000000050719 Konikoff <strong>Dental</strong> Associates 2100 Lynnhaven Pkwy, Suite 100 Virginia Beach VA 23456 General Provider Virginia Beach City<br />
* Parker Richard 000000050719 Konikoff <strong>Dental</strong> Associates 2100 Lynnhaven Pkwy, Suite 100 Virginia Beach VA 23456 General Provider Virginia Beach City<br />
* Parker Richard 000000050720 Konikoff <strong>Dental</strong> Associates 2301 A General Booth Blvd Virginia Beach VA 23456 General Provider Virginia Beach City<br />
* Pearl Dina 000000050719 Konikoff <strong>Dental</strong> Associates 2100 Lynnhaven Pkwy, Suite 100 Virginia Beach VA 23456 General Provider Virginia Beach City<br />
* Pearl Dina 000000050720 Konikoff <strong>Dental</strong> Associates 2301 A General Booth Blvd Virginia Beach VA 23456 General Provider Virginia Beach City<br />
* Reichley John 000000050719 Konikoff <strong>Dental</strong> Associates 2100 Lynnhaven Pkwy, Suite 100 Virginia Beach VA 23456 General Provider Virginia Beach City<br />
* Reichley John 000000050720 Konikoff <strong>Dental</strong> Associates 2301 A General Booth Blvd Virginia Beach VA 23456 General Provider Virginia Beach City<br />
* Richards Damdy 000000050719 Konikoff <strong>Dental</strong> Associates 2100 Lynnhaven Pkwy, Suite 100 Virginia Beach VA 23456 General Provider Virginia Beach City<br />
* Richards Damdy 000000050720 Konikoff <strong>Dental</strong> Associates 2301 A General Booth Blvd Virginia Beach VA 23456 General Provider Virginia Beach City<br />
* Santos Estelito 000000050719 Konikoff <strong>Dental</strong> Associates 2100 Lynnhaven Pkwy, Suite 100 Virginia Beach VA 23456 General Provider Virginia Beach City<br />
* Santos Estelito 000000050720 Konikoff <strong>Dental</strong> Associates 2301 A General Booth Blvd Virginia Beach VA 23456 General Provider Virginia Beach City<br />
* Solarte-Castro Edith 000000050719 Konikoff <strong>Dental</strong> Associates 2100 Lynnhaven Pkwy, Suite 100 Virginia Beach VA 23456 General Provider Virginia Beach City<br />
* Solarte-Castro Edith 000000050720 Konikoff <strong>Dental</strong> Associates 2301 A General Booth Blvd Virginia Beach VA 23456 General Provider Virginia Beach City<br />
* Tam Amy 000000050719 Konikoff <strong>Dental</strong> Associates 2100 Lynnhaven Pkwy, Suite 100 Virginia Beach VA 23456 General Provider Virginia Beach City<br />
* Tam Amy 000000050720 Konikoff <strong>Dental</strong> Associates 2301 A General Booth Blvd Virginia Beach VA 23456 General Provider Virginia Beach City<br />
* Throckmorton Maria 000000050719 Konikoff <strong>Dental</strong> Associates 2100 Lynnhaven Pkwy, Suite 100 Virginia Beach VA 23456 General Provider Virginia Beach City<br />
* Throckmorton Maria 000000050720 Konikoff <strong>Dental</strong> Associates 2301 A General Booth Blvd Virginia Beach VA 23456 General Provider Virginia Beach City<br />
Bergano Allan 000000000243 Allan L. Bergano, DDS, PC 256 N. Witchduck Rd., Unit D Virginia Beach VA 23462 General Provider Virginia Beach City<br />
* Karp Allen 000000001231 Allen Karp Family <strong>Dentist</strong>ry 4676 Princess Anne Rd, suite 100 Virginia Beach VA 23462 General Provider Virginia Beach City<br />
Ford Melvin Drs. Ford, Guter & Rai 5720 Greenwich Rd. Virginia Beach VA 23462 Oral Surgeon Virginia Beach City<br />
Guter Klaus Drs. Ford, Guter & Rai 5720 Greenwich Rd. Virginia Beach VA 23462 Oral Surgeon Virginia Beach City<br />
Rai Shaun Drs. Ford, Guter & Rai 5720 Greenwich Rd. Virginia Beach VA 23462 Oral Surgeon Virginia Beach City<br />
Ochave Frederick 000000001745 Frederick P. Ochave, D.M.D 289 Independence Blvd., Pembroke 3, Suite #229 Virginia Beach VA 23462 General Provider Virginia Beach City<br />
Kern Donald 000000001533 Harmony <strong>Dental</strong> Group / Donald F Kern DDS 401 Green Meadows Dr, Suite B Virginia Beach VA 23462 General Provider Virginia Beach City<br />
Scott Jon Jon L. Scott, D.D.S., M.S. 114 South Witchduck Rd. Virginia Beach VA 23462 Orthodontist Virginia Beach City<br />
* Gladstone Myron 000000000201 Drs. Gladstone & Salerno 5318 Providence Rd. Virginia Beach VA 23464 General Provider Virginia Beach City<br />
* Salerno James 000000000201 Drs. Gladstone & Salerno 5318 Providence Rd. Virginia Beach VA 23464 General Provider Virginia Beach City<br />
Smith Jacqueline 000000050338 Jacqueline B Smith DDS PLLC 1385 Fordham Dr, Suite 106 Virginia Beach VA 23464 General Provider Virginia Beach City<br />
Reynolds Jillian LWSS <strong>Dentist</strong>ry for Children 904 Kempsville Rd Virginia Beach VA 23464 Pedodontist Virginia Beach City<br />
Sachs Scott LWSS <strong>Dentist</strong>ry for Children 904 Kempsville Rd Virginia Beach VA 23464 Pedodontist Virginia Beach City<br />
Morrison Sanford S. Neil Morrison, DDS & Melvin R. Morrison, DDS 904 Kempsville Rd., Ste 102 Virginia Beach VA 23464 Oral Surgeon Virginia Beach City<br />
Conelias Trent Trent P. Conelias, DDS 6033 Providence Rd. Virginia Beach VA 23464 Oral Surgeon Virginia Beach City<br />
* Indicates dentist that is accepting current patients only.<br />
All <strong>Select</strong> <strong>Plan</strong> <strong>Dentist</strong>s Page 51<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 <strong>Dentist</strong>. Fac ID is used to indicate which facility a member chooses.