Provider Demographics
NPI:1598842486
Name:CHERMOL, EDWARD JOSEPH III (DMD, PC)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:JOSEPH
Last Name:CHERMOL
Suffix:III
Gender:M
Credentials:DMD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 W CHESTER PIKE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-3704
Mailing Address - Country:US
Mailing Address - Phone:610-353-0500
Mailing Address - Fax:610-353-1345
Practice Address - Street 1:3501 W CHESTER PIKE
Practice Address - Street 2:SUITE 102
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-3704
Practice Address - Country:US
Practice Address - Phone:610-353-0500
Practice Address - Fax:610-353-1345
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS027259L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA027259OtherLICENSCE NUMBER
PA200501893OtherTAX ID NUMBER