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General NPI Number Information
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NPI Number | 1063716611
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Entity Type | Organization
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Legal Business Name | CHESTNUT HILL DENTAL, INC.
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Dates
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Enumeration Date | 12/22/2010
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Last Update Date | 12/22/2010
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Provider Practice Location Address
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Address Line | 2 E CHESTNUT HILL AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19118-2715
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Country | US
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Telephone | 215-242-6404
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Fax | 215-242-4907
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Provider Business Mailing Address
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Address Line | 2 E CHESTNUT HILL AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19118-2715
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Country | US
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Telephone | 215-242-6404
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Fax | 215-242-4907
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBIN F. GALLAGHER
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Credential | D.M.D
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Telephone | 215-242-6404
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DS021970L
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License Number State | PA
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