Provider Demographics
NPI:1811416407
Name:ADVANCED FAMILY DENTAL CARE INC
Entity Type:Organization
Organization Name:ADVANCED FAMILY DENTAL CARE INC
Other - Org Name:ADVANCED FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PRAVEENA
Authorized Official - Middle Name:P
Authorized Official - Last Name:BHAT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:603-264-1445
Mailing Address - Street 1:613 AMHERST ST
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03063-1017
Mailing Address - Country:US
Mailing Address - Phone:603-882-3885
Mailing Address - Fax:
Practice Address - Street 1:613 AMHERST ST
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03063-1017
Practice Address - Country:US
Practice Address - Phone:603-882-3885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH03841261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH03841OtherNH DENTAL LICENSE