Provider Demographics
NPI:1538410204
Name:AMERI DENTAL GROUP P.C.
Entity type:Organization
Organization Name:AMERI DENTAL GROUP P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:AMISH
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:484-494-3300
Mailing Address - Street 1:875 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19023-2105
Mailing Address - Country:US
Mailing Address - Phone:484-494-3300
Mailing Address - Fax:484-494-5738
Practice Address - Street 1:875 MAIN ST
Practice Address - Street 2:
Practice Address - City:DARBY
Practice Address - State:PA
Practice Address - Zip Code:19023-2105
Practice Address - Country:US
Practice Address - Phone:484-494-3300
Practice Address - Fax:484-494-5738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-21
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS036851122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000520323-0002Medicaid
PA102689905-0001Medicaid
PA102274820-00002Medicaid