Provider Demographics
NPI:1841753902
Name:OPAL FAMILY DENTAL PC
Entity Type:Organization
Organization Name:OPAL FAMILY DENTAL PC
Other - Org Name:OPAL FAMILY DENTAL
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ADARSH
Authorized Official - Middle Name:
Authorized Official - Last Name:MODANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:610-558-0800
Mailing Address - Street 1:364 WILMINGTON W CHESTER PIKE STE A1
Mailing Address - Street 2:
Mailing Address - City:GLEN MILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19342-8207
Mailing Address - Country:US
Mailing Address - Phone:610-558-0800
Mailing Address - Fax:610-558-5848
Practice Address - Street 1:364 WILMINGTON PIKE STE A1
Practice Address - Street 2:
Practice Address - City:GLEN MILLS
Practice Address - State:PA
Practice Address - Zip Code:19342-1261
Practice Address - Country:US
Practice Address - Phone:610-488-2922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-07
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty