Provider Demographics
NPI:1457740532
Name:ACEDENTAL,PA,P.C.
Entity Type:Organization
Organization Name:ACEDENTAL,PA,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NABENDU
Authorized Official - Middle Name:K
Authorized Official - Last Name:MUKHERJEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:570-223-2400
Mailing Address - Street 1:9090 FRANKLIN HILL RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-9103
Mailing Address - Country:US
Mailing Address - Phone:570-223-2400
Mailing Address - Fax:570-223-2401
Practice Address - Street 1:9090 FRANKLIN HILL RD
Practice Address - Street 2:STE 202
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-9105
Practice Address - Country:US
Practice Address - Phone:570-223-2400
Practice Address - Fax:570-223-2401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS039899122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty