MEDICARE: ADVANCED AND ELITE DENTISTRY PC

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	261QD0000X	Dental Clinic/Center	DS029728L	PA

General Provider Information

NPI Number	:	1831597707
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED AND ELITE DENTISTRY PC

Provider Business Mailing Address
First Line	:	201 SECOND AVE
Second Line	:
City	:	COLLEGEVILLE
State	:	PA
Zip	:	19426-3613
Country	:	US
Telephone Number	:	610-454-7991
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 SECOND AVE
Second Line	:
City	:	COLLEGEVILLE
State	:	PA
Zip	:	19426-3613
Country	:	US
Telephone Number	:	610-454-7991
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DILIP N DUDHAT
Credential	:	DMD
Telephone Number	:	215-237-6099

Provider Enumeration Date	:	12/09/2014
Last Update Date	:	12/09/2014

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