Healthcare Provider Details

I. General information

NPI: 1184301061
Provider Name (Legal Business Name): PURVA SUBHASH DHOMNE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2023
Last Update Date: 07/03/2023
Certification Date: 06/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 HERITAGE DR STE 905
POTTSTOWN PA
19464-9223
US

IV. Provider business mailing address

1310 VALLEY DR
LANSDALE PA
19446-6648
US

V. Phone/Fax

Practice location:
  • Phone: 30-610-3239
  • Fax:
Mailing address:
  • Phone: 215-353-0280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS043966
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: