Provider Demographics
NPI:1326164963
Name:CHALFONT DENTAL CARE PC
Entity Type:Organization
Organization Name:CHALFONT DENTAL CARE PC
Other - Org Name:VARVARA CLARK DDS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:KRZACZYK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-822-6234
Mailing Address - Street 1:8 MEADOWBROOK LN
Mailing Address - Street 2:
Mailing Address - City:CHALFONT
Mailing Address - State:PA
Mailing Address - Zip Code:18914-2811
Mailing Address - Country:US
Mailing Address - Phone:215-822-6234
Mailing Address - Fax:215-822-6373
Practice Address - Street 1:8 MEADOWBROOK LN
Practice Address - Street 2:
Practice Address - City:CHALFONT
Practice Address - State:PA
Practice Address - Zip Code:18914-2811
Practice Address - Country:US
Practice Address - Phone:215-822-6234
Practice Address - Fax:215-822-6373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030518L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA006577OtherUNITED CONCORDIA