Provider Demographics
NPI:1306395223
Name:CHELSEA PEDIATRIC DENTISTRY LIC
Entity Type:Organization
Organization Name:CHELSEA PEDIATRIC DENTISTRY LIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NATASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-913-8620
Mailing Address - Street 1:45-45 21ST STREET
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-5219
Mailing Address - Country:US
Mailing Address - Phone:718-752-0001
Mailing Address - Fax:
Practice Address - Street 1:45-45 21ST STREET
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-5219
Practice Address - Country:US
Practice Address - Phone:718-752-0001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0554131223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty