Provider Demographics
NPI:1740727262
Name:ACADEMY DENTAL OF LEVITTOWN PA
Entity type:Organization
Organization Name:ACADEMY DENTAL OF LEVITTOWN PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:NAVLEEN
Authorized Official - Middle Name:K
Authorized Official - Last Name:THIND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:215-515-0700
Mailing Address - Street 1:102 EAGLES CHASE DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-2561
Mailing Address - Country:US
Mailing Address - Phone:732-318-7121
Mailing Address - Fax:
Practice Address - Street 1:197 KENWOOD DR N
Practice Address - Street 2:SUITE B
Practice Address - City:LEVITTOWN
Practice Address - State:PA
Practice Address - Zip Code:19055-2461
Practice Address - Country:US
Practice Address - Phone:215-515-0700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-22
Last Update Date:2017-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0394021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102872201-0001Medicaid