Provider Demographics
NPI:1346603636
Name:CHESTER HILL DENTAL ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:CHESTER HILL DENTAL ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHI
Authorized Official - Middle Name:D
Authorized Official - Last Name:FU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:914-937-2810
Mailing Address - Street 1:395 WESTCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:PORT CHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10573-3651
Mailing Address - Country:US
Mailing Address - Phone:914-937-2810
Mailing Address - Fax:914-937-0570
Practice Address - Street 1:395 WESTCHESTER AVE
Practice Address - Street 2:
Practice Address - City:PORT CHESTER
Practice Address - State:NY
Practice Address - Zip Code:10573-3651
Practice Address - Country:US
Practice Address - Phone:914-937-2810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-04
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028973261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental