Provider Demographics
NPI:1891110367
Name:CHESTNUT HILL DENTAL CARE
Entity Type:Organization
Organization Name:CHESTNUT HILL DENTAL CARE
Other - Org Name:CHESTNUT HILL SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSOCIATE
Authorized Official - Prefix:DR
Authorized Official - First Name:PALAK
Authorized Official - Middle Name:
Authorized Official - Last Name:JAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-247-4660
Mailing Address - Street 1:9 E HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19118-3307
Mailing Address - Country:US
Mailing Address - Phone:215-247-4660
Mailing Address - Fax:215-248-5739
Practice Address - Street 1:9 E HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19118-3307
Practice Address - Country:US
Practice Address - Phone:215-247-4660
Practice Address - Fax:215-248-5739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-20
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS039804261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADS039804OtherDEPARTMENT OF DENTISTRY PA
PADS039290OtherDENTAL LICENSE