Provider Demographics
NPI:1538445887
Name:AMERICAN DENTAL GROUP P.C.
Entity type:Organization
Organization Name:AMERICAN DENTAL GROUP P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MAHENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAKADIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-725-3939
Mailing Address - Street 1:1621 N CEDAR CREST BLVD STE 117
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-2312
Mailing Address - Country:US
Mailing Address - Phone:610-820-9900
Mailing Address - Fax:
Practice Address - Street 1:1621 N CEDAR CREST BLVD STE 117
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-2312
Practice Address - Country:US
Practice Address - Phone:610-820-9900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERICAN DENTAL GROUP P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS036851122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty