Provider Demographics
NPI:1942575782
Name:AFTON DENTAL AT RITTENHOUSE PC
Entity Type:Organization
Organization Name:AFTON DENTAL AT RITTENHOUSE PC
Other - Org Name:RITTENHOUSE DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NIKUNJ
Authorized Official - Middle Name:
Authorized Official - Last Name:ZALAVADIA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:215-546-2311
Mailing Address - Street 1:255 S 17TH ST
Mailing Address - Street 2:SUITE 2807
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-6231
Mailing Address - Country:US
Mailing Address - Phone:215-546-2311
Mailing Address - Fax:
Practice Address - Street 1:255 S 17TH ST
Practice Address - Street 2:SUITE 2807
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-6231
Practice Address - Country:US
Practice Address - Phone:215-546-2311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0379021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty