MEDICARE: AMERICAN DENTAL ASSOCIATES 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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1194153080
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICAN DENTAL ASSOCIATES PC

Provider Business Mailing Address
First Line	:	3428 RHAWN ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19136-2610
Country	:	US
Telephone Number	:	215-331-1330
Fax Number	:	215-333-3432

Provider Business Practice Location Address
First Line	:	3428 RHAWN ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19136-2610
Country	:	US
Telephone Number	:	215-331-1330
Fax Number	:	215-333-3432

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DILIP DUDHAT
Credential	:
Telephone Number	:	215-331-1330

Provider Enumeration Date	:	10/31/2013
Last Update Date	:	10/31/2013

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