Healthcare Provider Details

I. General information

NPI: 1699211698
Provider Name (Legal Business Name): CHESTER COUNTY ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2017
Last Update Date: 01/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 DOWLIN FORGE RD
EXTON PA
19341-1550
US

IV. Provider business mailing address

342 N MAIN ST STE 200
ALPHARETTA GA
30009-8376
US

V. Phone/Fax

Practice location:
  • Phone: 610-363-2100
  • Fax: 610-363-2120
Mailing address:
  • Phone: 770-744-4581
  • Fax: 678-550-5490

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: BRIAN SMITH
Title or Position: CFO
Credential:
Phone: 770-231-5348