Provider Demographics
NPI:1316780513
Name:ADVANCED COSMETIC AND IMPLANT DENTISTRY LLC
Entity type:Organization
Organization Name:ADVANCED COSMETIC AND IMPLANT DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:HITESHKUMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:NADA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:610-944-0551
Mailing Address - Street 1:501 N 17TH ST STE 107
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-5044
Mailing Address - Country:US
Mailing Address - Phone:484-350-3239
Mailing Address - Fax:
Practice Address - Street 1:501 N 17TH ST STE 107
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-5044
Practice Address - Country:US
Practice Address - Phone:484-350-3239
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-15
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental