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General NPI Number Information
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NPI Number | 1376083717
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Entity Type | Organization
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Legal Business Name | ADVANCE COSMETIC AND GENERAL DENTISTRY LLC
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Dates
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Enumeration Date | 03/05/2017
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Last Update Date | 03/05/2017
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Provider Practice Location Address
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Address Line | 3455 STREET RD STOC#6
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City | BENSALEM
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State | PA
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Zip | 19020-1542
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Country | US
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Telephone | 732-491-6437
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Fax |
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Provider Business Mailing Address
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Address Line | 101 DORSET AVE
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City | CROYDON
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State | PA
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Zip | 19021-6224
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | BHAVIN SHAH
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Credential | DDS
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Telephone | 732-491-6437
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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 | DS037553
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License Number State | PA
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