Provider Demographics
NPI:1518583418
Name:ADVANCED DENTISTRY OF MAIN LINE PC
Entity Type:Organization
Organization Name:ADVANCED DENTISTRY OF MAIN LINE 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:DMD
Authorized Official - Phone:215-390-4672
Mailing Address - Street 1:365 LANCASTER AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-1867
Mailing Address - Country:US
Mailing Address - Phone:610-993-8770
Mailing Address - Fax:
Practice Address - Street 1:365 LANCASTER AVE STE 5
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-1867
Practice Address - Country:US
Practice Address - Phone:610-993-8770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-17
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental