Provider Demographics
NPI:1972074250
Name:CENTER ONE DENTAL ASSOCIATES PC
Entity Type:Organization
Organization Name:CENTER ONE DENTAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JATIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOVALIA
Authorized Official - Suffix:
Authorized Official - Credentials:MANAGER
Authorized Official - Phone:215-673-4888
Mailing Address - Street 1:9880 BUSTLETON AVE STE 213
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-2143
Mailing Address - Country:US
Mailing Address - Phone:215-464-4888
Mailing Address - Fax:
Practice Address - Street 1:9880 BUSTLETON AVE STE 213
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-2143
Practice Address - Country:US
Practice Address - Phone:215-464-4888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-11
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental