MEDICARE: COLLINGDALE DENTISTRY

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	DSO35539	PA

General Provider Information

NPI Number	:	1336626514
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLLINGDALE DENTISTRY

Provider Business Mailing Address
First Line	:	500 PEMBROKE AVE
Second Line	:
City	:	EAST LANSDOWNE
State	:	PA
Zip	:	19050-2518
Country	:	US
Telephone Number	:	610-457-5671
Fax Number	:	610-259-3557

Provider Business Practice Location Address
First Line	:	724 MACDADE BLVD
Second Line	:
City	:	COLLINGDALE
State	:	PA
Zip	:	19023-3825
Country	:	US
Telephone Number	:	610-457-5671
Fax Number	:	610-259-3557

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. DINESH S TEWARI
Credential	:	DMD
Telephone Number	:	610-457-5671

Provider Enumeration Date	:	07/20/2018
Last Update Date	:	07/20/2018

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Directions to “COLLINGDALE DENTISTRY ” Practice Location

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