Provider Demographics
NPI:1083892335
Name:CHASE PLAZA DENTAL CLINIC LLC
Entity Type:Organization
Organization Name:CHASE PLAZA DENTAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:202-362-3353
Mailing Address - Street 1:5406 CONNECTICUT AVE NW
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20015-2858
Mailing Address - Country:US
Mailing Address - Phone:202-362-3353
Mailing Address - Fax:202-362-8648
Practice Address - Street 1:5406 CONNECTICUT AVE NW
Practice Address - Street 2:SUITE 102
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20015-2858
Practice Address - Country:US
Practice Address - Phone:202-362-3353
Practice Address - Fax:202-362-8648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN4412122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty