Provider Demographics
NPI:1700032562
Name:EVAN CHAFITZ DMD PC
Entity Type:Organization
Organization Name:EVAN CHAFITZ DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINTEROS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-901-1964
Mailing Address - Street 1:1075 CENTRAL PARK AVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-3242
Mailing Address - Country:US
Mailing Address - Phone:914-472-5252
Mailing Address - Fax:914-722-5987
Practice Address - Street 1:1075 CENTRAL PARK AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-3242
Practice Address - Country:US
Practice Address - Phone:914-472-5252
Practice Address - Fax:914-722-5987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-13
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0438471223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYD13801Medicare PIN
NYD13801Medicare Oscar/Certification