Provider Demographics
NPI:1912207903
Name:PETER F. CHASE D.D.S., INC.
Entity Type:Organization
Organization Name:PETER F. CHASE D.D.S., INC.
Other - Org Name:MEDICAL DENTAL CONCEPTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:F
Authorized Official - Last Name:CHASE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:925-935-2918
Mailing Address - Street 1:130 LA CASA VIA BLDG 2
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-3045
Mailing Address - Country:US
Mailing Address - Phone:925-935-2918
Mailing Address - Fax:925-935-1532
Practice Address - Street 1:130 LA CASA VIA BLDG 2
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3045
Practice Address - Country:US
Practice Address - Phone:925-935-2918
Practice Address - Fax:925-935-2918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22480122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty