Provider Demographics
NPI:1780771428
Name:CHORAZY, CHESTER JOHN (DDS MDS)
Entity type:Individual
Prefix:
First Name:CHESTER
Middle Name:JOHN
Last Name:CHORAZY
Suffix:
Gender:M
Credentials:DDS MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 WASHINGTON ROAD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15221-4437
Mailing Address - Country:US
Mailing Address - Phone:412-683-6551
Mailing Address - Fax:
Practice Address - Street 1:131 WASHINGTON ROAD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15221-4437
Practice Address - Country:US
Practice Address - Phone:412-683-6551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS014774L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00536922Medicaid
PA00536922Medicaid
PA00536922Medicaid
251186897OtherEIN#