Provider Demographics
NPI:1548420441
Name:DREXEL HILL FAMILY DENTISTRY
Entity Type:Organization
Organization Name:DREXEL HILL FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DINESH
Authorized Official - Middle Name:S
Authorized Official - Last Name:TEWARI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:610-457-5671
Mailing Address - Street 1:4244 FERNE BLVD
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-3809
Mailing Address - Country:US
Mailing Address - Phone:610-259-6619
Mailing Address - Fax:610-259-3557
Practice Address - Street 1:4244 FERNE BLVD
Practice Address - Street 2:
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-3809
Practice Address - Country:US
Practice Address - Phone:610-259-6619
Practice Address - Fax:610-259-3557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADSO35539122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty