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General NPI Number Information
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NPI Number | 1407578289
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Entity Type | Organization
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Legal Business Name | LIBERTY DENTAL ASSOCIATES PC
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Dates
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Enumeration Date | 09/16/2022
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Last Update Date | 09/16/2022
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Provider Practice Location Address
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Address Line | 300 SCHUYLKILL RD FL 1
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City | PHOENIXVILLE
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State | PA
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Zip | 19460-5202
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Country | US
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Telephone | 215-390-4672
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Fax |
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Provider Business Mailing Address
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Address Line | 300 SCHUYLKILL RD FL 1
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City | PHOENIXVILLE
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State | PA
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Zip | 19460-5202
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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 | DILIP DUDHAT
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Credential |
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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 |
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License Number State |
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