Provider Demographics
NPI:1285009357
Name:CHESTNUT HILL SMILES, LLC
Entity Type:Organization
Organization Name:CHESTNUT HILL SMILES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:LANZILOTTI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:609-870-0720
Mailing Address - Street 1:1511 HANCOCK ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-3126
Mailing Address - Country:US
Mailing Address - Phone:609-870-0720
Mailing Address - Fax:
Practice Address - Street 1:139 E CHESTNUT HILL RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-4043
Practice Address - Country:US
Practice Address - Phone:609-870-0720
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-01
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG1-0001257122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty