Provider Demographics
NPI:1972891851
Name:ADVANCE DENTAL CARE CONSULTANTS
Entity type:Organization
Organization Name:ADVANCE DENTAL CARE CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:AZIZ
Authorized Official - Last Name:GHANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-564-1679
Mailing Address - Street 1:1225 VINE ST
Mailing Address - Street 2:STE 401
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-1116
Mailing Address - Country:US
Mailing Address - Phone:215-564-1679
Mailing Address - Fax:
Practice Address - Street 1:1225 VINE ST
Practice Address - Street 2:STE 401
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-1116
Practice Address - Country:US
Practice Address - Phone:215-564-1679
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-13
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0371711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty