Provider Demographics
NPI:1003529959
Name:DENTIST OF PAOLI INC
Entity Type:Organization
Organization Name:DENTIST OF PAOLI INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RUTIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:AGRAWAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-889-8896
Mailing Address - Street 1:63 CHESTNUT RD STE B
Mailing Address - Street 2:
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1535
Mailing Address - Country:US
Mailing Address - Phone:610-889-8896
Mailing Address - Fax:610-889-8897
Practice Address - Street 1:63 CHESTNUT RD STE B
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1535
Practice Address - Country:US
Practice Address - Phone:610-889-8896
Practice Address - Fax:610-889-8897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental