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General NPI Number Information
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NPI Number | 1538393392
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Entity Type | Organization
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Legal Business Name | AU DENTAL
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Dates
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Enumeration Date | 05/08/2009
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Last Update Date | 05/08/2009
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Provider Practice Location Address
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Address Line | 10000 ROOSEVELT BLVD
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City | PHILADELPHIA
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State | PA
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Zip | 19116-3901
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Country | US
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Telephone | 215-676-0222
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Fax | 215-676-0224
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Provider Business Mailing Address
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Address Line | 10000 ROOSEVELT BLVD
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City | PHILADELPHIA
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State | PA
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Zip | 19116-3901
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Country | US
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Telephone | 215-676-0222
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Fax | 215-676-0224
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | GAGAN UPPAL
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Credential | DMD
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Telephone | 215-676-0222
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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 | DS037672
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License Number State | PA
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