Provider Demographics
NPI:1265085864
Name:ACCESS DENTISTRY, LLC
Entity type:Organization
Organization Name:ACCESS DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE
Authorized Official - Prefix:DR
Authorized Official - First Name:DINESH
Authorized Official - Middle Name:S
Authorized Official - Last Name:TEWARI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:610-457-5671
Mailing Address - Street 1:6760 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-2449
Mailing Address - Country:US
Mailing Address - Phone:610-436-8485
Mailing Address - Fax:610-583-0931
Practice Address - Street 1:6760 MARKET ST
Practice Address - Street 2:
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-2449
Practice Address - Country:US
Practice Address - Phone:610-436-8485
Practice Address - Fax:610-583-0931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-23
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1215051958Medicaid