# NORTHEASTERN DENTISTRY AT COTTMAN

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1306141080
- **Authorized official:** DR. KAVITHA CHADHALAVADA DDS (OWNER DENTIST)
- **Authorized official phone:** (856) 325-0560

## Contact information

- **Practice address:** 1936 COTTMAN AVE, 2ND FLOOR, PHILADELPHIA, PA 19111-3800
- **Practice address phone:** (215) 728-0777
- **Practice address fax:** (877) 707-5571
- **Mailing address:** 1936 COTTMAN AVE, 2ND FLOOR, PHILADELPHIA, PA 19111-3800
- **Mailing address phone:** (215) 728-0777
- **Mailing address fax:** (877) 707-5571

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | DS037335 | PA | Yes |

## Other

- **Enumeration date:** 01/11/2011
- **Last updated:** 07/30/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1020256650006 | — | PA |