Provider Demographics
NPI:1952713554
Name:CHESTER COUNTY COMMUNITY DENTAL CENTER
Entity Type:Organization
Organization Name:CHESTER COUNTY COMMUNITY DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:HORTON
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-383-3888
Mailing Address - Street 1:744 E LINCOLN HWY
Mailing Address - Street 2:STE 120
Mailing Address - City:COATESVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19320-3590
Mailing Address - Country:US
Mailing Address - Phone:610-383-3888
Mailing Address - Fax:
Practice Address - Street 1:744 E LINCOLN HWY
Practice Address - Street 2:STE 120
Practice Address - City:COATESVILLE
Practice Address - State:PA
Practice Address - Zip Code:19320-3590
Practice Address - Country:US
Practice Address - Phone:610-383-3888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-30
Last Update Date:2014-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADH005232L261QD0000X
PAPHDH000185261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care