Northeastern Dentistry @ Overbrook

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

NORTHEASTERN DENTISTRY @ OVERBROOK

Practice address

6554 Lebanon Ave
Philadelphia, PA 19151-3328

Phone

(215) 878-0058

Fax

(877) 707-5571

NPI assigned

Mar 7, 2011

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, DDSNPI 1295924736

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.

• Kavitha Chadhalavada

  • Dentist
  • Philadelphia, PA
  • NPI 1295924736
  NPD (past) Authorized official

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

{
    "created_epoch": "1299456000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475193600000",
    "number": "1699073239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6554 LEBANON AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191513328",
            "telephone_number": "215-878-0058",
            "fax_number": "877-707-5571"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6554 LEBANON AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191513328",
            "telephone_number": "215-878-0058",
            "fax_number": "877-707-5571"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEASTERN DENTISTRY @ OVERBROOK",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-07",
        "last_updated": "2016-09-30",
        "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": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1020256650007",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Northeast Treatment Centers, Inc.
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• Northeast Women'S Center, Inc.
• Northeastern Cardiology Associates, LTD.
• Northeastern Dentistry at Cottman
• Northeastern Urological Associates
• Northern Home Children and Family Service
• Northern Home for Children and Family Service
• Northern Home for Children and Family Service

• 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 Sep 30, 2016; 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.