1881808665 NPI number — DILIP N DUDHAT, DMD,PC

Table of content: (NPI 1881808665)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881808665 NPI number — DILIP N DUDHAT, DMD,PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DILIP N DUDHAT, DMD,PC
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:
ADVANCED DENTAL ESTHETICS
Provider Other Organization Name Type Code:
3
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:
1881808665
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2406 N BROAD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLMAR
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18915-9701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-997-2300
Provider Business Mailing Address Fax Number:
215-997-0227

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2406 N BROAD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLMAR
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18915-9701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-997-2300
Provider Business Practice Location Address Fax Number:
215-997-0227
Provider Enumeration Date:
05/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DUDHAT
Authorized Official First Name:
DILIP
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
215-997-2300

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  DS029728L , 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: 28956 . This is a "AETNA ID" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 136588 . This is a "UNITED CONCORDIA ID" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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