Provider Demographics
NPI:1124446125
Name:MVP FAMILY DENTAL,LLC
Entity type:Organization
Organization Name:MVP FAMILY DENTAL,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VINEETHA
Authorized Official - Middle Name:M
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:215-887-7171
Mailing Address - Street 1:8302 OLD YORK RD
Mailing Address - Street 2:SUITE B-10
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-1522
Mailing Address - Country:US
Mailing Address - Phone:215-887-7171
Mailing Address - Fax:215-885-5630
Practice Address - Street 1:1653 THE FAIRWAY
Practice Address - Street 2:BAEDERWOOD OFFICES,SUITE 205
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-1420
Practice Address - Country:US
Practice Address - Phone:215-887-7171
Practice Address - Fax:215-885-5630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-07
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty