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General NPI Number Information
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NPI Number | 1972074250
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Entity Type | Organization
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Legal Business Name | CENTER ONE DENTAL ASSOCIATES PC
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Dates
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Enumeration Date | 12/11/2018
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Last Update Date | 01/02/2019
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Provider Practice Location Address
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Address Line | 9880 BUSTLETON AVE STE 213
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City | PHILADELPHIA
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State | PA
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Zip | 19115-2143
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Country | US
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Telephone | 215-464-4888
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Fax |
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Provider Business Mailing Address
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Address Line | 9880 BUSTLETON AVE STE 213
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City | PHILADELPHIA
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State | PA
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Zip | 19115-2143
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Country | US
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Telephone | 215-464-4888
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Fax |
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Authorized Official
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Title or Position | MANAGER/PRESIDENT
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Name | MR. JATIN MOVALIA
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Credential | MANAGER
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Telephone | 215-673-4888
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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 |
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License Number State |
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