Provider Demographics
NPI:1770074429
Name:AMERICAN DENTAL HEALTH, PC
Entity type:Organization
Organization Name:AMERICAN DENTAL HEALTH, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PRAFULCHANDRA
Authorized Official - Middle Name:G
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:267-221-6070
Mailing Address - Street 1:109 EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:AMBLER
Mailing Address - State:PA
Mailing Address - Zip Code:19002-2413
Mailing Address - Country:US
Mailing Address - Phone:215-297-3500
Mailing Address - Fax:215-542-6979
Practice Address - Street 1:9229 ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-2205
Practice Address - Country:US
Practice Address - Phone:215-297-3500
Practice Address - Fax:215-542-6979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-29
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS020804-L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty