Provider Demographics
NPI:1457421091
Name:JONATHAN CHASE DDS PC
Entity Type:Organization
Organization Name:JONATHAN CHASE DDS PC
Other - Org Name:CHASE ORTHODONTICS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHASE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:781-438-2100
Mailing Address - Street 1:61 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-3364
Mailing Address - Country:US
Mailing Address - Phone:781-438-2100
Mailing Address - Fax:781-438-0681
Practice Address - Street 1:61 MAIN ST
Practice Address - Street 2:
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-3364
Practice Address - Country:US
Practice Address - Phone:781-438-2100
Practice Address - Fax:781-438-0681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA170091223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty