Provider Demographics
NPI:1467529511
Name:CHADDS FORD DENTAL VILLAGE
Entity Type:Organization
Organization Name:CHADDS FORD DENTAL VILLAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SIAD
Authorized Official - Middle Name:HUSSIEN
Authorized Official - Last Name:MOHAMED-ALI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:610-459-4915
Mailing Address - Street 1:98 ROUTE 202 AT PA DE LINE
Mailing Address - Street 2:
Mailing Address - City:CHADDS FORD
Mailing Address - State:PA
Mailing Address - Zip Code:19317
Mailing Address - Country:US
Mailing Address - Phone:610-459-4915
Mailing Address - Fax:610-459-9752
Practice Address - Street 1:98 ROUTE 202 AT PA DE LINE
Practice Address - Street 2:
Practice Address - City:CHADDS FORD
Practice Address - State:PA
Practice Address - Zip Code:19317
Practice Address - Country:US
Practice Address - Phone:610-459-4915
Practice Address - Fax:610-459-9752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS020611L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty