Provider Demographics
NPI:1073904454
Name:ADVANCED DENTISTRY OF WESTTOWN PC
Entity Type:Organization
Organization Name:ADVANCED DENTISTRY OF WESTTOWN PC
Other - Org Name:ADVANCED DENTISTRY OF WESTTOWN
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:DUDHAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-431-3310
Mailing Address - Street 1:1580 MCDANIEL DR
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-6673
Mailing Address - Country:US
Mailing Address - Phone:610-431-3310
Mailing Address - Fax:
Practice Address - Street 1:1580 MCDANIEL DR
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-6673
Practice Address - Country:US
Practice Address - Phone:610-431-3310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-06
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029728122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty