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NPI Code Detail

MEDICARE: PA DENTAL GROUP LLC

MEDICARE: PA DENTAL GROUP LLC
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
1122300000XDentist

General Provider Information

NPI Number : 1316323371
Entity Type Code : Organization
Provider Name (Legal Business Name) : PA DENTAL GROUP LLC
Provider Business Mailing Address
First Line : 320 N OXFORD VALLEY RD
Second Line :
City : FAIRLESS HILLS
State : PA
Zip : 19030-2610
Country : US
Telephone Number : 215-946-9400
Fax Number : 215-946-9409
Provider Business Practice Location Address
First Line : 320 N OXFORD VALLEY RD
Second Line :
City : FAIRLESS HILLS
State : PA
Zip : 19030-2610
Country : US
Telephone Number : 215-946-9400
Fax Number : 215-946-9409
Authorized Official
Title or Position : MANAGER
Name : PARUL TRIVEDI
Credential :
Telephone Number : 215-946-9400
Provider Enumeration Date : 07/31/2015
Last Update Date : 07/31/2015

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Directions to “PA DENTAL GROUP LLC ” Practice Location

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