Provider Demographics
NPI:1336812445
Name:DYNAMIC DENTAL CARE, LLC
Entity Type:Organization
Organization Name:DYNAMIC DENTAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENAGER
Authorized Official - Prefix:
Authorized Official - First Name:BHAUMIK
Authorized Official - Middle Name:
Authorized Official - Last Name:KANANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-446-5662
Mailing Address - Street 1:6507 HICKORY RD
Mailing Address - Street 2:
Mailing Address - City:MACUNGIE
Mailing Address - State:PA
Mailing Address - Zip Code:18062-8739
Mailing Address - Country:US
Mailing Address - Phone:610-849-2042
Mailing Address - Fax:
Practice Address - Street 1:141 E EMAUS AVE
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-5824
Practice Address - Country:US
Practice Address - Phone:213-446-5662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-26
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty