Healthcare Provider Details

I. General information

NPI: 1285814905
Provider Name (Legal Business Name): FLORAL VALE DENTAL EXCELLENCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2007
Last Update Date: 11/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 FLORAL VALE BLVD SUITE C
YARDLEY PA
19067-5522
US

IV. Provider business mailing address

117 FLORAL VALE BLVD SUITE C
YARDLEY PA
19067-5522
US

V. Phone/Fax

Practice location:
  • Phone: 215-860-4600
  • Fax: 215-860-1455
Mailing address:
  • Phone: 215-860-4600
  • Fax: 215-860-1455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number029728
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerPRIVATE DENTAL PRACTICE

VIII. Authorized Official

Name: JAY DUDHAT
Title or Position: OFFICE MANAGER
Credential:
Phone: 215-860-4600