Provider Demographics
NPI:1417113382
Name:EXCEL DENTAL CARE, P.C.
Entity Type:Organization
Organization Name:EXCEL DENTAL CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMRUTHA
Authorized Official - Middle Name:CHANDRA
Authorized Official - Last Name:MANDAVA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:518-452-2121
Mailing Address - Street 1:1662 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-4001
Mailing Address - Country:US
Mailing Address - Phone:518-452-2121
Mailing Address - Fax:
Practice Address - Street 1:1662 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-4001
Practice Address - Country:US
Practice Address - Phone:518-452-2121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-31
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty