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General NPI Number Information
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NPI Number | 1366868689
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Entity Type | Organization
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Legal Business Name | LANSDALE FAMILY DENTISTRY PC
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Dates
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Enumeration Date | 03/11/2014
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Last Update Date | 03/11/2014
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Provider Practice Location Address
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Address Line | 2031 N BROAD ST SUITE 143
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City | LANSDALE
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State | PA
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Zip | 19446-1063
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Country | US
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Telephone | 215-393-8400
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Fax | 215-393-5409
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Provider Business Mailing Address
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Address Line | 2031 N BROAD ST SUITE 143
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City | LANSDALE
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State | PA
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Zip | 19446-1063
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Country | US
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Telephone | 215-393-8400
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Fax | 215-393-5409
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Authorized Official
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Title or Position | DENTIST
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Name | MR. DILIP N DUDHAT
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Credential | D.M.D
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Telephone | 215-237-6099
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DS029728L
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License Number State | PA
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