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General NPI Number Information
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NPI Number | 1770074429
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Entity Type | Organization
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Legal Business Name | AMERICAN DENTAL HEALTH, PC
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Dates
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Enumeration Date | 05/29/2018
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Last Update Date | 05/29/2018
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Provider Practice Location Address
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Address Line | 9229 ROOSEVELT BLVD
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City | PHILADELPHIA
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State | PA
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Zip | 19114-2205
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Country | US
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Telephone | 215-297-3500
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Fax | 215-542-6979
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Provider Business Mailing Address
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Address Line | 109 EXECUTIVE DR
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City | AMBLER
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State | PA
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Zip | 19002-2413
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Country | US
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Telephone | 215-297-3500
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Fax | 215-542-6979
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Authorized Official
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Title or Position | CEO
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Name | DR. PRAFULCHANDRA G PATEL
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Credential | DDS
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Telephone | 267-221-6070
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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 | DS020804-L
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License Number State | PA
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