=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215482674
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTER FOR DENTISTRY, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2016
-----------------------------------------------------
Last Update Date | 08/15/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 938 CHESTER PIKE
-----------------------------------------------------
City | SHARON HILL
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19079-1413
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-457-5671
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 938 CHESTER PIKE
-----------------------------------------------------
City | SHARON HILL
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19079-1413
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-457-5671
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. DINESH S TEWARI
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 610-457-5671
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | DSO35539
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------