MEDICARE: ADVANCED DENTISTRY OF CENTER CITY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1558913129
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED DENTISTRY OF CENTER CITY

Provider Business Mailing Address
First Line	:	1601 WALNUT ST STE 600
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-2904
Country	:	US
Telephone Number	:	215-564-1446
Fax Number	:

Provider Business Practice Location Address
First Line	:	1601 WALNUT ST STE 600
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-2904
Country	:	US
Telephone Number	:	215-564-1446
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DILIP DUDHAT
Credential	:
Telephone Number	:	215-237-6099

Provider Enumeration Date	:	07/12/2019
Last Update Date	:	07/12/2019

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