Provider Demographics
NPI:1770695355
Name:PEDIATRIC DENTISTRY OF CLEVELAND, LLC
Entity type:Organization
Organization Name:PEDIATRIC DENTISTRY OF CLEVELAND, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:S
Authorized Official - Last Name:ESLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:423-476-2160
Mailing Address - Street 1:150 STUART XING NE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-4065
Mailing Address - Country:US
Mailing Address - Phone:423-476-2160
Mailing Address - Fax:423-476-2680
Practice Address - Street 1:430 STUART RD NE
Practice Address - Street 2:SUITE 1
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-4918
Practice Address - Country:US
Practice Address - Phone:423-476-2160
Practice Address - Fax:423-476-2680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN77631223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3206748Medicaid