Healthcare Provider Details

I. General information

NPI: 1780771428
Provider Name (Legal Business Name): CHESTER JOHN CHORAZY DDS MDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 07/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 WASHINGTON ROAD
PITTSBURGH PA
15221-4437
US

IV. Provider business mailing address

131 WASHINGTON ROAD
PITTSBURGH PA
15221-4437
US

V. Phone/Fax

Practice location:
  • Phone: 412-683-6551
  • Fax:
Mailing address:
  • Phone: 412-683-6551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDS014774L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: