MEDICARE: PA DENTAL GROUP

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

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

NPI Number	:	1487981767
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PA DENTAL GROUP

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	:	OFFICE MANAGER
Name	:	PRIYA BAROT
Credential	:
Telephone Number	:	215-946-9400

Provider Enumeration Date	:	11/08/2009
Last Update Date	:	11/08/2009

322 N OXFORD VALLEY RD
FAIRLESS HILLS, PA
19030-2610

Practice Phone: 215-943-4050
Practice Fax: