=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912291576
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WHITEMARSH DENTAL CARE,INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/01/2011
-----------------------------------------------------
Last Update Date | 10/25/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400R GERMANTOWN PIKE
-----------------------------------------------------
City | LAFAYETTE HILL
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19444-1804
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-825-7444
-----------------------------------------------------
Fax | 610-825-6002
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9 CAMELOT WAY
-----------------------------------------------------
City | HARLEYSVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19438-2910
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-825-7444
-----------------------------------------------------
Fax | 610-825-6002
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER DENTIST
-----------------------------------------------------
Name | JYOTI DESHMANE
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 610-825-7444
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------