Provider Demographics
NPI:1639198286
Name:CHETLIN, JEFFREY D (DDS-MDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:D
Last Name:CHETLIN
Suffix:
Gender:M
Credentials:DDS-MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 MURRAY AVENUE
Mailing Address - Street 2:SUITE #305
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15217-1657
Mailing Address - Country:US
Mailing Address - Phone:412-421-5112
Mailing Address - Fax:
Practice Address - Street 1:1900 MURRAY AVE
Practice Address - Street 2:SUITE #305
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15217-1657
Practice Address - Country:US
Practice Address - Phone:412-421-5112
Practice Address - Fax:412-421-5116
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0275211223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics