Organization
NORTHEASTERN DENTISTRY @ CLIFTON HEIGHTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KAVITHA CHADHALAVADA (OWNER DENTIST)
(856) 325-0560
Entity
Organization
Contact information
Practice address
44 W BALTIMORE AVE, CLIFTON HEIGHTS, PA 19018-2201
(610) 622-2684
(877) 707-5571
Mailing address
44 W BALTIMORE AVE, CLIFTON HEIGHTS, PA 19018-2201
(610) 622-2684
(877) 707-5571
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DS037335
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1020256650008
—
PA
Enumeration date
10/18/2012
Last updated
07/30/2013
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