Healthcare Provider Details

I. General information

NPI: 1144125212
Provider Name (Legal Business Name): MAKE AMERICA SMILE AGAIN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/10/2026
Certification Date: 10/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 ROUTE 100 STE 2A
BARTO PA
19504-8724
US

IV. Provider business mailing address

1309 ROUTE 100 STE 2A
BARTO PA
19504-8724
US

V. Phone/Fax

Practice location:
  • Phone: 267-500-1591
  • Fax:
Mailing address:
  • Phone: 267-500-1591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. MAYUR K DUDHAT
Title or Position: DENTIST
Credential: DDS
Phone: 267-500-1591