Provider Demographics
NPI:1336200732
Name:CHANA WELLER DDS PLLC
Entity Type:Organization
Organization Name:CHANA WELLER DDS PLLC
Other - Org Name:ADVANCED DENTISTRY ASSOCIATES
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHANA
Authorized Official - Middle Name:L
Authorized Official - Last Name:WELLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS PLLC
Authorized Official - Phone:212-721-8373
Mailing Address - Street 1:41 WEST 72ND STREET
Mailing Address - Street 2:#10
Mailing Address - City:NY
Mailing Address - State:NY
Mailing Address - Zip Code:10023
Mailing Address - Country:US
Mailing Address - Phone:212-721-8373
Mailing Address - Fax:
Practice Address - Street 1:41 WEST 72ND STREET
Practice Address - Street 2:#10
Practice Address - City:NYC
Practice Address - State:NY
Practice Address - Zip Code:10023
Practice Address - Country:US
Practice Address - Phone:212-721-8373
Practice Address - Fax:212-721-8373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039533122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty