| Northeastern Dentistry @ Overbrook | |
|
6554 Lebanon Ave Philadelphia PA 19151-3328 | |
| (215) 878-0058 | |
| (877) 707-5571 |
| Full Name | Northeastern Dentistry @ Overbrook |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 6554 Lebanon Ave, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Kavitha Chadhalavada (OWNER DENTIST) |
| Authorized Official Contact | 8563250560 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Northeastern Dentistry @ Overbrook 6554 Lebanon Ave Philadelphia PA 19151-3328 Ph: (215) 878-0058 | Northeastern Dentistry @ Overbrook 6554 Lebanon Ave Philadelphia PA 19151-3328 Ph: (215) 878-0058 |
| NPI Number | 1699073239 |
|---|---|
| Provider Enumeration Date | 03/07/2011 |
| Last Update Date | 09/30/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699073239 | NPI | - | NPPES |
| 1020256650007 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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