Basic Information
| Provider Information | |||||||||
| NPI: | 1265763684 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CHASE DENTAL HEALTH, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1357 | ||||||||
| Address2: | |||||||||
| City: | BAYVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117090357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5167944161 | ||||||||
| FaxNumber: | 5167949568 | ||||||||
| Practice Location | |||||||||
| Address1: | 324 S SERVICE RD | ||||||||
| Address2: | |||||||||
| City: | MELVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117473270 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314562130 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2010 | ||||||||
| LastUpdateDate: | 01/25/2010 | ||||||||
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| AuthorizedOfficialLastName: | CHASE | ||||||||
| AuthorizedOfficialFirstName: | BARRY | ||||||||
| AuthorizedOfficialMiddleName: | N | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6314562130 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DDS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 032187 | NY | Y | 193200000X MULTI-SPECIALTY GROUP | Dental Providers | Dentist | General Practice |
No ID Information.