Provider Demographics
NPI:1124442876
Name:AMERICAN DENTAL SPECIALTIES PC
Entity type:Organization
Organization Name:AMERICAN DENTAL SPECIALTIES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:AMISH
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-820-9901
Mailing Address - Street 1:1651 N CEDAR CREST BLVD STE 206B
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-2316
Mailing Address - Country:US
Mailing Address - Phone:610-820-9901
Mailing Address - Fax:610-820-9922
Practice Address - Street 1:1651 N CEDAR CREST BLVD STE 206B
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-2316
Practice Address - Country:US
Practice Address - Phone:610-820-9901
Practice Address - Fax:610-820-9922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-14
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty