# NORTHEASTERN DENTISTRY @ CLIFTON HEIGHTS

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

## Provider details

- **NPI number:** 1881947505
- **Authorized official:** DR. KAVITHA CHADHALAVADA (OWNER DENTIST)
- **Authorized official phone:** (856) 325-0560

## Contact information

- **Practice address:** 44 W BALTIMORE AVE, CLIFTON HEIGHTS, PA 19018-2201
- **Practice address phone:** (610) 622-2684
- **Practice address fax:** (877) 707-5571
- **Mailing address:** 44 W BALTIMORE AVE, CLIFTON HEIGHTS, PA 19018-2201
- **Mailing address phone:** (610) 622-2684
- **Mailing address fax:** (877) 707-5571

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | DS037335 | PA | Yes |

## Other

- **Enumeration date:** 10/18/2012
- **Last updated:** 07/30/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1020256650008 | — | PA |