Provider Demographics
NPI:1548415243
Name:ADVANCED DENTISTRY OF COLLEGEVILLE PC
Entity Type:Organization
Organization Name:ADVANCED DENTISTRY OF COLLEGEVILLE PC
Other - Org Name:ADVANCED DENTISTRY OF COLLEGEVILLE PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EME NELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SILVA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:610-489-5555
Mailing Address - Street 1:399 ARCOLA RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-3906
Mailing Address - Country:US
Mailing Address - Phone:610-489-5555
Mailing Address - Fax:
Practice Address - Street 1:399 ARCOLA RD
Practice Address - Street 2:SUITE 100
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426-3906
Practice Address - Country:US
Practice Address - Phone:610-489-5555
Practice Address - Fax:610-489-5163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-21
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1223D0004X, 1223E0200X, 1223G0001X, 1223P0221X, 1223P0300X, 1223S0112X, 124Q00000X
PADS036175305S00000X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No1223D0004XDental ProvidersDentistDentist AnesthesiologistGroup - Single Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Single Specialty
No305S00000XManaged Care OrganizationsPoint of ServiceGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA6528690001Medicare NSC