Healthcare Provider Details

I. General information

NPI: 1699178657
Provider Name (Legal Business Name): CHCL ORTHODONTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2014
Last Update Date: 10/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

842 DACULA RD SUITE 102
DACULA GA
30019-3185
US

IV. Provider business mailing address

842 DACULA RD SUITE 102
DACULA GA
30019-3185
US

V. Phone/Fax

Practice location:
  • Phone: 770-963-0083
  • Fax: 770-963-0084
Mailing address:
  • Phone: 770-963-0083
  • Fax: 770-963-0084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. CESAR HUMBERTO CARDENAS
Title or Position: OWNER/PRESIDENT
Credential: DMD
Phone: 770-963-0083