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General NPI Number Information
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NPI Number | 1457740532
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Entity Type | Organization
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Legal Business Name | ACEDENTAL,PA,P.C.
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Dates
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Enumeration Date | 01/13/2015
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Last Update Date | 01/13/2015
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Provider Practice Location Address
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Address Line | 9090 FRANKLIN HILL RD STE 202
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City | EAST STROUDSBURG
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State | PA
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Zip | 18301-9105
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Country | US
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Telephone | 570-223-2400
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Fax | 570-223-2401
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Provider Business Mailing Address
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Address Line | 9090 FRANKLIN HILL RD SUITE 202
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City | EAST STROUDSBURG
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State | PA
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Zip | 18301-9103
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Country | US
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Telephone | 570-223-2400
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Fax | 570-223-2401
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Authorized Official
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Title or Position | CEO
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Name | NABENDU K MUKHERJEE
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Credential | DDS
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Telephone | 570-223-2400
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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 | DS039899
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License Number State | PA
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