Organization
NORTHEASTERN DENTISTRY @ OVERBROOK
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
6554 LEBANON AVE, PHILADELPHIA, PA 19151-3328
(215) 878-0058
(877) 707-5571
Mailing address
6554 LEBANON AVE, PHILADELPHIA, PA 19151-3328
(215) 878-0058
(877) 707-5571
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1020256650007
—
PA
Enumeration date
03/07/2011
Last updated
09/30/2016
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