Healthcare Provider Details

I. General information

NPI: 1336685320
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: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 E MARSHALL ST STE 200
WEST CHESTER PA
19380-4400
US

IV. Provider business mailing address

2300 LAKEVIEW PKWY STE 250
ALPHARETTA GA
30009-3954
US

V. Phone/Fax

Practice location:
  • Phone: 610-918-2400
  • Fax:
Mailing address:
  • Phone: 470-207-3264
  • 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

VIII. Authorized Official

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