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General NPI Number Information
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NPI Number | 1053780585
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Entity Type | Organization
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Legal Business Name | AMERICAN DENTAL HEALTH,PC
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Dates
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Enumeration Date | 09/15/2015
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Last Update Date | 09/15/2015
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Provider Practice Location Address
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Address Line | 6784 MARKET ST
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City | UPPER DARBY
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State | PA
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Zip | 19082-2431
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Country | US
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Telephone | 484-462-0171
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Fax | 215-646-1005
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Provider Business Mailing Address
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Address Line | 6784 MARKET STRRET
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City | UPPER DARBY
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State | PA
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Zip | 19082
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Country | US
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Telephone | 484-462-0171
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Fax | 215-646-1005
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Authorized Official
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Title or Position | CEO
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Name | DR. PRAFULCHANDRA G PATEL
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Credential | DDS
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Telephone | 267-221-6070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DS020408-L
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License Number State | PA
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