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General NPI Number Information
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NPI Number | 1952713554
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Entity Type | Organization
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Legal Business Name | CHESTER COUNTY COMMUNITY DENTAL CENTER
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Dates
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Enumeration Date | 05/30/2014
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Last Update Date | 05/30/2014
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Provider Practice Location Address
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Address Line | 744 E LINCOLN HWY STE 120
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City | COATESVILLE
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State | PA
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Zip | 19320-3590
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Country | US
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Telephone | 610-383-3888
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Fax |
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Provider Business Mailing Address
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Address Line | 744 E LINCOLN HWY STE 120
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City | COATESVILLE
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State | PA
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Zip | 19320-3590
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Country | US
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Telephone | 610-383-3888
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. REGINA HORTON LEWIS
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Credential |
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Telephone | 610-383-3888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | PHDH000185
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DH005232L
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License Number State | PA
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