Organization
NORTHEASTERN DENTISTRY AT COTTMAN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KAVITHA CHADHALAVADA DDS (OWNER DENTIST)
(856) 325-0560
Entity
Organization
Contact information
Practice address
1936 COTTMAN AVE, 2ND FLOOR, PHILADELPHIA, PA 19111-3800
(215) 728-0777
(877) 707-5571
Mailing address
1936 COTTMAN AVE, 2ND FLOOR, PHILADELPHIA, PA 19111-3800
(215) 728-0777
(877) 707-5571
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DS037335
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1020256650006
—
PA
Enumeration date
01/11/2011
Last updated
07/30/2013
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