Provider Demographics
NPI:1851045942
Name:FLEETWOOD FAMILY DENTAL CARE LLC
Entity Type:Organization
Organization Name:FLEETWOOD FAMILY DENTAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HITESHKUMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:NADA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:610-944-0551
Mailing Address - Street 1:438 PARK RD
Mailing Address - Street 2:
Mailing Address - City:FLEETWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19522-8687
Mailing Address - Country:US
Mailing Address - Phone:610-944-0551
Mailing Address - Fax:
Practice Address - Street 1:438 PARK RD
Practice Address - Street 2:
Practice Address - City:FLEETWOOD
Practice Address - State:PA
Practice Address - Zip Code:19522-8687
Practice Address - Country:US
Practice Address - Phone:610-944-0551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-08
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental