# ADVANCED DENTAL CONCEPTS OF BROOMALL PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063394880
- **Authorized official:** MR. KETAV R SHAH (VICE PRESIDENT)
- **Authorized official phone:** (610) 353-6161

## Contact information

- **Practice address:** 2193 W CHESTER PIKE, BROOMALL, PA 19008-3029
- **Practice address phone:** (610) 353-6161
- **Mailing address:** 2193 W CHESTER PIKE, BROOMALL, PA 19008-3029
- **Mailing address phone:** (610) 353-6161

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 07/23/2025
- **Last updated:** 07/23/2025