Provider Demographics
NPI:1427222652
Name:AMERICAN DENTAL PRACTICE PC
Entity Type:Organization
Organization Name:AMERICAN DENTAL PRACTICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:INDERPAL
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:GARCHA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:518-218-2292
Mailing Address - Street 1:2258 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:GUILDERLAND
Mailing Address - State:NY
Mailing Address - Zip Code:12084-9701
Mailing Address - Country:US
Mailing Address - Phone:518-218-2292
Mailing Address - Fax:518-218-2293
Practice Address - Street 1:2258 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:GUILDERLAND
Practice Address - State:NY
Practice Address - Zip Code:12084-9701
Practice Address - Country:US
Practice Address - Phone:518-218-2292
Practice Address - Fax:518-218-2293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050067122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02504887Medicaid