Provider Demographics
NPI:1801958327
Name:CHESTNUTHILL DENTAL GROUP, P.C.
Entity type:Organization
Organization Name:CHESTNUTHILL DENTAL GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:570-402-4001
Mailing Address - Street 1:PO BOX 1089
Mailing Address - Street 2:MIDTOWN PLAZA, RT 209
Mailing Address - City:BRODHEADSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18322-1089
Mailing Address - Country:US
Mailing Address - Phone:570-402-4001
Mailing Address - Fax:570-402-4002
Practice Address - Street 1:MIDTOWN PLAZA, RT 209
Practice Address - Street 2:
Practice Address - City:BRODHEADSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18322-1089
Practice Address - Country:US
Practice Address - Phone:570-402-4001
Practice Address - Fax:570-402-4002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS- 029560-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty