Provider Demographics
NPI:1699231118
Name:MEDIA DENTAL ASSOCIATES DMD LLC
Entity type:Organization
Organization Name:MEDIA DENTAL ASSOCIATES DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JITEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:GOHEL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:610-565-0525
Mailing Address - Street 1:511 N PROVIDENCE RD
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-2518
Mailing Address - Country:US
Mailing Address - Phone:610-565-0525
Mailing Address - Fax:610-565-4724
Practice Address - Street 1:511 N PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-2518
Practice Address - Country:US
Practice Address - Phone:610-565-0525
Practice Address - Fax:610-565-4724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-20
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty