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General NPI Number Information
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NPI Number | 1386815785
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Entity Type | Organization
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Legal Business Name | PATELKA DENTAL LLC
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Dates
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Enumeration Date | 03/13/2008
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Last Update Date | 03/13/2008
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Provider Practice Location Address
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Address Line | 8332 BUSTLETON AVE UNIT C
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City | PHILADELPHIA
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State | PA
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Zip | 19152-1909
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Country | US
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Telephone | 215-342-9000
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Fax | 215-342-9100
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Provider Business Mailing Address
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Address Line | 8332 BUSTLETON AVE UNIT C
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City | PHILADELPHIA
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State | PA
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Zip | 19152-1909
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Country | US
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Telephone | 215-342-9000
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Fax | 215-342-9100
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Authorized Official
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Title or Position | GENERAL DENTIST
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Name | RASIK G PATEL
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Credential | DDS
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Telephone | 215-342-9000
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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 | DS020408L
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License Number State | PA
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