Northeastern Dentistry at Cottman

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DS037335 Issued in PA

Legal business name

NORTHEASTERN DENTISTRY AT COTTMAN

Practice address

1936 Cottman Ave
2ND Floor
Philadelphia, PA 19111-3800

Phone

(215) 728-0777

Fax

(877) 707-5571

NPI assigned

Jan 11, 2011

Last updated

Jul 30, 2013By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Kavitha Chadhalavada, DDS

Title

Owner Dentist

Phone

(856) 325-0560

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Lemuel Pidlaon, DDS

  • General Practice Dentistry
  • Philadelphia, PA
  • NPI 1922172071
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1294704000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1375142400000",
    "number": "1306141080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1936 COTTMAN AVE",
            "address_2": "2ND FLOOR",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191113800",
            "telephone_number": "215-728-0777",
            "fax_number": "877-707-5571"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1936 COTTMAN AVE",
            "address_2": "2ND FLOOR",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191113800",
            "telephone_number": "215-728-0777",
            "fax_number": "877-707-5571"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEASTERN DENTISTRY AT COTTMAN",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-11",
        "last_updated": "2013-07-30",
        "status": "A",
        "authorized_official_last_name": "CHADHALAVADA",
        "authorized_official_first_name": "KAVITHA",
        "authorized_official_title_or_position": "OWNER DENTIST",
        "authorized_official_telephone_number": "856-325-0560",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS037335",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1020256650006",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• General Practice Dentistry in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.