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General NPI Number Information
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NPI Number | 1538445887
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Entity Type | Organization
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Legal Business Name | AMERICAN DENTAL GROUP P.C.
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Dates
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Enumeration Date | 11/01/2011
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Last Update Date | 11/01/2011
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Provider Practice Location Address
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Address Line | 1621 N CEDAR CREST BLVD STE 117
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City | ALLENTOWN
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State | PA
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Zip | 18104-2312
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Country | US
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Telephone | 610-820-9900
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Fax |
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Provider Business Mailing Address
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Address Line | 1621 N CEDAR CREST BLVD STE 117
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City | ALLENTOWN
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State | PA
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Zip | 18104-2312
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Country | US
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Telephone | 610-820-9900
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Fax |
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | MR. MAHENDRA KAKADIA
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Credential |
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Telephone | 646-725-3939
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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 | DS036851
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License Number State | PA
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