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General NPI Number Information
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NPI Number | 1881947505
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Entity Type | Organization
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Legal Business Name | NORTHEASTERN DENTISTRY @ CLIFTON HEIGHTS
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Dates
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Enumeration Date | 10/18/2012
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Last Update Date | 07/30/2013
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Provider Practice Location Address
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Address Line | 44 W BALTIMORE AVE
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City | CLIFTON HEIGHTS
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State | PA
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Zip | 19018-2201
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Country | US
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Telephone | 610-622-2684
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Fax | 877-707-5571
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Provider Business Mailing Address
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Address Line | 44 W BALTIMORE AVE
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City | CLIFTON HEIGHTS
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State | PA
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Zip | 19018-2201
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Country | US
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Telephone | 610-622-2684
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Fax | 877-707-5571
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | DR. KAVITHA CHADHALAVADA
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Credential |
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Telephone | 856-325-0560
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DS037335
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License Number State | PA
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