Healthcare Provider Details

I. General information

NPI: 1437709953
Provider Name (Legal Business Name): CHESTER SPRINGS ORTHODONTICS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2019
Last Update Date: 09/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 GORDON DR
EXTON PA
19341-1285
US

IV. Provider business mailing address

609 GORDON DR
EXTON PA
19341-1285
US

V. Phone/Fax

Practice location:
  • Phone: 610-202-7730
  • Fax: 610-524-9709
Mailing address:
  • Phone: 610-202-7730
  • Fax: 610-524-9709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: KARL ROBERT CEDERQUIST
Title or Position: PRESIDENT
Credential: DDS
Phone: 610-202-7730