Provider Demographics
NPI:1700820735
Name:CHIALASTRI, GREGG MARTIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGG
Middle Name:MARTIN
Last Name:CHIALASTRI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 APACHE LN
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-2306
Mailing Address - Country:US
Mailing Address - Phone:610-828-1924
Mailing Address - Fax:610-828-1924
Practice Address - Street 1:600 APACHE LN
Practice Address - Street 2:
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-2306
Practice Address - Country:US
Practice Address - Phone:610-828-1924
Practice Address - Fax:610-828-1924
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0205511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice