Provider Demographics
NPI:1346617263
Name:AMERICAN DENTAL CARE,LLC
Entity Type:Organization
Organization Name:AMERICAN DENTAL CARE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:PRAFULCHANDRA
Authorized Official - Middle Name:G
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:267-221-6070
Mailing Address - Street 1:109 EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:AMBLER
Mailing Address - State:PA
Mailing Address - Zip Code:19002-2413
Mailing Address - Country:US
Mailing Address - Phone:267-221-6070
Mailing Address - Fax:215-646-1005
Practice Address - Street 1:6784 MARKET ST
Practice Address - Street 2:
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-2431
Practice Address - Country:US
Practice Address - Phone:484-462-0171
Practice Address - Fax:215-646-1005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-26
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-020804-L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty