MEDICARE: ADVANCED DENTAL SMILES

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1215263645
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED DENTAL SMILES

Provider Business Mailing Address
First Line	:	533 N YORK RD
Second Line	:
City	:	HATBORO
State	:	PA
Zip	:	19040-2038
Country	:	US
Telephone Number	:	215-672-9444
Fax Number	:	215-672-9144

Provider Business Practice Location Address
First Line	:	533 N YORK RD
Second Line	:
City	:	HATBORO
State	:	PA
Zip	:	19040-2038
Country	:	US
Telephone Number	:	215-672-9444
Fax Number	:	215-672-9144

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. JATIN K MOVALIA
Credential	:
Telephone Number	:	215-237-1544

Provider Enumeration Date	:	10/20/2009
Last Update Date	:	10/20/2009

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Directions to “ADVANCED DENTAL SMILES ” Practice Location

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