MEDICARE: AMERICAN DENTAL HEALTH,PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DS020408-L	PA

General Provider Information

NPI Number	:	1053780585
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICAN DENTAL HEALTH,PC

Provider Business Mailing Address
First Line	:	6784 MARKET STRRET
Second Line	:
City	:	UPPER DARBY
State	:	PA
Zip	:	19082
Country	:	US
Telephone Number	:	484-462-0171
Fax Number	:	215-646-1005

Provider Business Practice Location Address
First Line	:	6784 MARKET ST
Second Line	:
City	:	UPPER DARBY
State	:	PA
Zip	:	19082-2431
Country	:	US
Telephone Number	:	484-462-0171
Fax Number	:	215-646-1005

Authorized Official
Title or Position	:	CEO
Name	:	DR. PRAFULCHANDRA G PATEL
Credential	:	DDS
Telephone Number	:	267-221-6070

Provider Enumeration Date	:	09/15/2015
Last Update Date	:	09/15/2015

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