Provider Demographics
NPI:1285814905
Name:FLORAL VALE DENTAL EXCELLENCE
Entity Type:Organization
Organization Name:FLORAL VALE DENTAL EXCELLENCE
Other - Org Name:ADVANCED DENTAL EXCELLENCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUDHAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-860-4600
Mailing Address - Street 1:117 FLORAL VALE BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-5522
Mailing Address - Country:US
Mailing Address - Phone:215-860-4600
Mailing Address - Fax:215-860-1455
Practice Address - Street 1:117 FLORAL VALE BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-5522
Practice Address - Country:US
Practice Address - Phone:215-860-4600
Practice Address - Fax:215-860-1455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0297281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1OtherPRIVATE DENTAL PRACTICE