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General NPI Number Information
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NPI Number | 1457421091
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Entity Type | Organization
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Legal Business Name | JONATHAN CHASE DDS PC
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 09/08/2008
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Provider Practice Location Address
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Address Line | 61 MAIN ST
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City | STONEHAM
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State | MA
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Zip | 02180-3364
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Country | US
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Telephone | 781-438-2100
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Fax | 781-438-0681
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Provider Business Mailing Address
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Address Line | 61 MAIN ST
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City | STONEHAM
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State | MA
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Zip | 02180-3364
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Country | US
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Telephone | 781-438-2100
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Fax | 781-438-0681
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JONATHAN CHASE
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Credential | DDS
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Telephone | 781-438-2100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 17009
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License Number State | MA
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