Provider Demographics
NPI:1790707289
Name:RICHARD E. CHODROFF, D.M.D.
Entity Type:Organization
Organization Name:RICHARD E. CHODROFF, D.M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:CHODROFF
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:302-995-6979
Mailing Address - Street 1:3105 LIMESTONE RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-2147
Mailing Address - Country:US
Mailing Address - Phone:302-995-6979
Mailing Address - Fax:302-995-6645
Practice Address - Street 1:3105 LIMESTONE RD
Practice Address - Street 2:SUITE 203
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-2147
Practice Address - Country:US
Practice Address - Phone:302-995-6979
Practice Address - Fax:302-995-6645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE9141223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000881108Medicaid