Organization
COLLINGDALE DENTAL ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AAKASH C MUDALIAR DMD (VICE PRESIDENT)
(570) 309-8223
Entity
Organization
Contact information
Practice address
224 CLIFTON AVE, COLLINGDALE, PA 19023-3712
(610) 583-3454
Mailing address
224 CLIFTON AVE, COLLINGDALE, PA 19023-3712
(610) 583-3454
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DS038564
PA
261QD0000X
Dental Clinic/Center
DS041461
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DS038564
PENNSYLVANIA STATE BOARD OF DENTISTRY
PA
01
—
DS041461
PENNSYLVANIA STATE BOARD OF DENTISTRY
PA
Enumeration date
03/11/2018
Last updated
03/11/2018
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