Provider Demographics
NPI:1669686168
Name:BLUE BELL DENTAL ASSOC. PC
Entity Type:Organization
Organization Name:BLUE BELL DENTAL ASSOC. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JITESH
Authorized Official - Middle Name:V
Authorized Official - Last Name:BOGHARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-278-0420
Mailing Address - Street 1:1515 DEKALB PIKE SUITE 111
Mailing Address - Street 2:
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422
Mailing Address - Country:US
Mailing Address - Phone:610-278-0420
Mailing Address - Fax:610-278-6938
Practice Address - Street 1:1515 DEKALB PIKE SUITE 111
Practice Address - Street 2:
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-3367
Practice Address - Country:US
Practice Address - Phone:610-278-0420
Practice Address - Fax:610-278-6938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029728L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1902970718OtherDR. AIDA PASALIC
PA1588080105OtherDR. ANKIT KARSALIA
PA1407041429OtherDR. PADMA RAMAN
PA1124033774OtherDR. DILIP DUDHAT