Provider Demographics
NPI:1154838068
Name:CHATHAM SQUARE DENTAL ASSOCIATE, PC
Entity Type:Organization
Organization Name:CHATHAM SQUARE DENTAL ASSOCIATE, PC
Other - Org Name:CHATHAM SQUARE DENTAL ASSOCIATE PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:HO
Authorized Official - Last Name:NGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:212-385-8080
Mailing Address - Street 1:7 CHATHAM SQ RM 503
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-1000
Mailing Address - Country:US
Mailing Address - Phone:212-385-8080
Mailing Address - Fax:212-385-8082
Practice Address - Street 1:7 CHATHAM SQ RM 503
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-1000
Practice Address - Country:US
Practice Address - Phone:212-385-8080
Practice Address - Fax:212-385-8082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-02
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty