MEDICARE: AMERICAN FAMILY DENTAL CARE P.C.

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	DS-029417-L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447391396
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICAN FAMILY DENTAL CARE P.C.

Provider Business Mailing Address
First Line	:	11911 BUSTLETON AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19116-2541
Country	:	US
Telephone Number	:	215-673-9050
Fax Number	:	215-673-9052

Provider Business Practice Location Address
First Line	:	11911 BUSTLETON AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19116-2541
Country	:	US
Telephone Number	:	215-673-9050
Fax Number	:	215-673-9052

Authorized Official
Title or Position	:	DMD
Name	:	BHASKAR M SAVANI
Credential	:
Telephone Number	:	215-673-9050

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	06/13/2008

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