Provider Demographics
NPI:1083251839
Name:CHITVAN DENTAL PLLC
Entity Type:Organization
Organization Name:CHITVAN DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHITVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:518-248-1659
Mailing Address - Street 1:70 GLEN ST STE 240
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-2859
Mailing Address - Country:US
Mailing Address - Phone:516-759-0086
Mailing Address - Fax:516-344-8128
Practice Address - Street 1:70 GLEN ST STE 240
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2859
Practice Address - Country:US
Practice Address - Phone:516-759-0086
Practice Address - Fax:516-344-8128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-27
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty