1265658280 NPI number — PRAFULL M DOSHI, D.D.S. P.C.

Table of content: (NPI 1265658280)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265658280 NPI number — PRAFULL M DOSHI, D.D.S. P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRAFULL M DOSHI, D.D.S. P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265658280
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1032 PARK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLANDON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19510-9558
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-926-9300
Provider Business Mailing Address Fax Number:
610-926-8622

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1032 PARK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLANDON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19510-9558
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-926-9300
Provider Business Practice Location Address Fax Number:
610-926-8622
Provider Enumeration Date:
04/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DOSHI
Authorized Official First Name:
PRAFULL
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
610-926-9300

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  DSO19781-L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000044787 . This is a "DENTAL BENEFIT PROVIDERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0005419191 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1313837 . This is a "UNITED CONCORDIA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000190326 . This is a "MED ASST UNISON" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 9184421 . This is a "MEDICAL ASSISTANCE (DORAL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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