Provider Demographics
NPI:1417975343
Name:MOKTAN DENTAL CARE
Entity Type:Organization
Organization Name:MOKTAN DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER & DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HRIDAI
Authorized Official - Middle Name:
Authorized Official - Last Name:MOKTAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-363-7550
Mailing Address - Street 1:105 COEWAY LN
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2240
Mailing Address - Country:US
Mailing Address - Phone:610-363-7550
Mailing Address - Fax:610-363-7551
Practice Address - Street 1:105 COEWAY LN
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2240
Practice Address - Country:US
Practice Address - Phone:610-363-7550
Practice Address - Fax:610-363-7551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS031048L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty