Provider Demographics
NPI:1790222974
Name:PEDIATRIC DENTAL HEALTH LLC
Entity type:Organization
Organization Name:PEDIATRIC DENTAL HEALTH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MUKUND
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:215-433-1840
Mailing Address - Street 1:2842 STREET RD
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-2651
Mailing Address - Country:US
Mailing Address - Phone:215-433-1840
Mailing Address - Fax:412-317-1568
Practice Address - Street 1:2842 STREET RD
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-2651
Practice Address - Country:US
Practice Address - Phone:215-433-1840
Practice Address - Fax:412-317-1568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-25
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADSO387991223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty