Provider Demographics
NPI:1730507963
Name:UPPER DARBY DENTISTRY,
Entity type:Organization
Organization Name:UPPER DARBY DENTISTRY,
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DINESH
Authorized Official - Middle Name:S
Authorized Official - Last Name:TEWARI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:610-457-5671
Mailing Address - Street 1:653 LONG LN
Mailing Address - Street 2:
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-5230
Mailing Address - Country:US
Mailing Address - Phone:610-457-5671
Mailing Address - Fax:484-461-7666
Practice Address - Street 1:653 LONG LN
Practice Address - Street 2:
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-5230
Practice Address - Country:US
Practice Address - Phone:610-457-5671
Practice Address - Fax:484-461-7666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-04
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADSO35539122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty