Provider Demographics
NPI:1447578737
Name:CARL, CHAYA P (DDS)
Entity Type:Individual
Prefix:
First Name:CHAYA
Middle Name:P
Last Name:CARL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MRS
Other - First Name:CHAYA
Other - Middle Name:P
Other - Last Name:SISKIND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:89 GENESEE ST
Mailing Address - Street 2:HEALTHREACH
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14611-3201
Mailing Address - Country:US
Mailing Address - Phone:585-368-3720
Mailing Address - Fax:585-368-3723
Practice Address - Street 1:89 GENESEE ST
Practice Address - Street 2:HEALTHREACH
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14611-3201
Practice Address - Country:US
Practice Address - Phone:585-368-3720
Practice Address - Fax:585-368-3723
Is Sole Proprietor?:No
Enumeration Date:2010-05-11
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0554921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03387657Medicaid