Healthcare Provider Details

I. General information

NPI: 1245322692
Provider Name (Legal Business Name): CHESTER CO ENDODONITCS SOUTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 MCFARLAN RD SUITE 302
KENNETT SQUARE PA
19348
US

IV. Provider business mailing address

404 MCFARLAN RD SUITE 302
KENNETT SQUARE PA
19348
US

V. Phone/Fax

Practice location:
  • Phone: 610-925-3440
  • Fax: 610-925-3421
Mailing address:
  • Phone: 610-925-3440
  • Fax: 610-925-3421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDS018600L
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DR. ROBERT M KRAUSS
Title or Position: PRESIDENT
Credential: DMD
Phone: 610-925-3440