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General NPI Number Information
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NPI Number | 1669686168
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Entity Type | Organization
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Legal Business Name | BLUE BELL DENTAL ASSOC. PC
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 04/26/2022
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Provider Practice Location Address
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Address Line | 1515 DEKALB PIKE SUITE 111
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City | BLUE BELL
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State | PA
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Zip | 19422-3367
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Country | US
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Telephone | 610-278-0420
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Fax | 610-278-6938
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Provider Business Mailing Address
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Address Line | 1515 DEKALB PIKE SUITE 111
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City | BLUE BELL
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State | PA
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Zip | 19422
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Country | US
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Telephone | 610-278-0420
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Fax | 610-278-6938
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Authorized Official
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Title or Position | OWNER
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Name | MR. JITESH V BOGHARA
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Credential |
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Telephone | 610-278-0420
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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 | DS029728L
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License Number State | PA
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