Healthcare Provider Details

I. General information

NPI: 1255594842
Provider Name (Legal Business Name): DANA KRISTANNE CHIANESE DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 09/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 E ALLEGHENY AVE STE 201
PHILADELPHIA PA
19134-4427
US

IV. Provider business mailing address

226 MONROE ST APT D
PHILADELPHIA PA
19147-3361
US

V. Phone/Fax

Practice location:
  • Phone: 215-282-8000
  • Fax: 215-427-1782
Mailing address:
  • Phone: 732-779-0619
  • Fax: 732-349-5475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDS038432
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: