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General NPI Number Information
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NPI Number | 1477946119
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Entity Type | Organization
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Legal Business Name | CHETLIN PECHERSKY ORTHODONTICS
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Dates
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Enumeration Date | 03/05/2015
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Last Update Date | 03/05/2015
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Provider Practice Location Address
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Address Line | 1900 MURRAY AVE SUITE 305
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City | PITTSBURGH
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State | PA
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Zip | 15217-1657
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Country | US
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Telephone | 412-421-5112
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Fax | 412-421-5116
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Provider Business Mailing Address
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Address Line | 1900 MURRAY AVENUE SUITE 305
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City | PITTSBURGH
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State | PA
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Zip | 15217
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Country | US
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Telephone | 412-421-5112
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Fax | 412-421-5116
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Authorized Official
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Title or Position | OWNER
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Name | DR. JEFFREY D CHETLIN
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Credential | DDS
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Telephone | 412-421-5112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | DS027521L
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License Number State | PA
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