Provider Demographics
NPI:1326179524
Name:ROBERT M CHIDECKEL,DMD
Entity Type:Organization
Organization Name:ROBERT M CHIDECKEL,DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:CHIDECKEL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:610-876-8038
Mailing Address - Street 1:3309 EDGMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:19015-2830
Mailing Address - Country:US
Mailing Address - Phone:610-876-8038
Mailing Address - Fax:610-876-2910
Practice Address - Street 1:3309 EDGMONT AVE
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:PA
Practice Address - Zip Code:19015-2830
Practice Address - Country:US
Practice Address - Phone:610-876-8038
Practice Address - Fax:610-876-2910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS022107L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty