Provider Demographics
NPI:1134266760
Name:CHILTON DENTAL GROUP LLC
Entity type:Organization
Organization Name:CHILTON DENTAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PARDEEP
Authorized Official - Middle Name:K
Authorized Official - Last Name:SIDHU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:908-352-4438
Mailing Address - Street 1:465 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07208-1737
Mailing Address - Country:US
Mailing Address - Phone:908-352-4438
Mailing Address - Fax:908-352-4525
Practice Address - Street 1:465 NORTH AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07208-1737
Practice Address - Country:US
Practice Address - Phone:908-352-4438
Practice Address - Fax:908-352-4525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI222411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty