Provider Demographics
NPI:1851983936
Name:SEVENTY SIX DENTAL PC
Entity Type:Organization
Organization Name:SEVENTY SIX DENTAL PC
Other - Org Name:DANTA DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/FOUNDER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:215-561-5559
Mailing Address - Street 1:1919 CHESTNUT ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103
Mailing Address - Country:US
Mailing Address - Phone:215-561-5559
Mailing Address - Fax:215-561-1399
Practice Address - Street 1:1919 CHESTNUT ST
Practice Address - Street 2:SUITE 101
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103
Practice Address - Country:US
Practice Address - Phone:215-561-5559
Practice Address - Fax:215-561-1399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-09
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Multi-Specialty