Provider Demographics
NPI:1881808665
Name:DILIP N DUDHAT, DMD,PC
Entity type:Organization
Organization Name:DILIP N DUDHAT, DMD,PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:DUDHAT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:215-997-2300
Mailing Address - Street 1:2406 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:COLMAR
Mailing Address - State:PA
Mailing Address - Zip Code:18915-9701
Mailing Address - Country:US
Mailing Address - Phone:215-997-2300
Mailing Address - Fax:215-997-0227
Practice Address - Street 1:2406 N BROAD ST
Practice Address - Street 2:
Practice Address - City:COLMAR
Practice Address - State:PA
Practice Address - Zip Code:18915-9701
Practice Address - Country:US
Practice Address - Phone:215-997-2300
Practice Address - Fax:215-997-0227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029728L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA28956OtherAETNA ID
PA136588OtherUNITED CONCORDIA ID