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General NPI Number Information
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NPI Number | 1104519792
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Entity Type | Organization
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Legal Business Name | CHESTER WOODS FAMILY DENTISTRY, LLC
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Dates
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Enumeration Date | 05/30/2023
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Last Update Date | 05/30/2023
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Provider Practice Location Address
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Address Line | 385 ROUTE 24 STE 1D
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City | CHESTER
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State | NJ
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Zip | 07930-2908
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Country | US
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Telephone | 908-224-9994
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Fax |
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Provider Business Mailing Address
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Address Line | 385 ROUTE 24 STE 1D
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City | CHESTER
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State | NJ
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Zip | 07930-2908
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Country | US
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Telephone | 908-224-9994
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Fax |
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Authorized Official
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Title or Position | OWNER - DENTIST
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Name | CARINA FAIRFIELD
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Credential | DMD
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Telephone | 973-525-2721
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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