Provider Demographics
NPI:1326755075
Name:ELKINS PARK DENTAL INNOVATIONS PC
Entity Type:Organization
Organization Name:ELKINS PARK DENTAL INNOVATIONS PC
Other - Org Name:
Other - Org Type:
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:215-237-6099
Mailing Address - Street 1:118 KINGSTON WAY
Mailing Address - Street 2:
Mailing Address - City:NORTH WALES
Mailing Address - State:PA
Mailing Address - Zip Code:19454-4528
Mailing Address - Country:US
Mailing Address - Phone:215-390-3488
Mailing Address - Fax:
Practice Address - Street 1:200 YORKTOWN PLZ
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-1424
Practice Address - Country:US
Practice Address - Phone:215-885-6565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental