Provider Demographics
NPI:1972734507
Name:D3 DENTAL, PC
Entity Type:Organization
Organization Name:D3 DENTAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JATIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOVALIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-619-6756
Mailing Address - Street 1:1126B HORSHAM ROAD
Mailing Address - Street 2:
Mailing Address - City:AMBLER
Mailing Address - State:PA
Mailing Address - Zip Code:19002-1178
Mailing Address - Country:US
Mailing Address - Phone:215-619-6756
Mailing Address - Fax:
Practice Address - Street 1:1126B HORSHAM ROAD
Practice Address - Street 2:
Practice Address - City:AMBLER
Practice Address - State:PA
Practice Address - Zip Code:19002-1178
Practice Address - Country:US
Practice Address - Phone:215-619-6756
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-30
Last Update Date:2010-02-01
Deactivation Date:2009-08-17
Deactivation Code:
Reactivation Date:2010-01-28
Provider Licenses
StateLicense IDTaxonomies
PA1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty