Healthcare Provider Details

I. General information

NPI: 1265658280
Provider Name (Legal Business Name): PRAFULL M DOSHI, D.D.S. P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1032 PARK RD
BLANDON PA
19510-9558
US

IV. Provider business mailing address

1032 PARK RD
BLANDON PA
19510-9558
US

V. Phone/Fax

Practice location:
  • Phone: 610-926-9300
  • Fax: 610-926-8622
Mailing address:
  • Phone: 610-926-9300
  • Fax: 610-926-8622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDSO19781-L
License Number StatePA

VIII. Authorized Official

Name: DR. PRAFULL M DOSHI
Title or Position: OWNER
Credential: DDS
Phone: 610-926-9300