Healthcare Provider Details

I. General information

NPI: 1912592288
Provider Name (Legal Business Name): DENTIST OF CHESTER SPRINGS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2021
Last Update Date: 03/08/2021
Certification Date: 03/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1024 POTTSTOWN PIKE
CHESTER SPRINGS PA
19425-3511
US

IV. Provider business mailing address

1024 POTTSTOWN PIKE
CHESTER SPRINGS PA
19425-3511
US

V. Phone/Fax

Practice location:
  • Phone: 610-885-8856
  • Fax:
Mailing address:
  • Phone: 610-885-8856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number StateNULL

VIII. Authorized Official

Name: RUTIKA AGRAWAL
Title or Position: PRESIDENT/DENTIST
Credential: MD
Phone: 201-286-8231