Basic Information
| Provider Information | |||||||||
| NPI: | 1124140694 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CHOMIAK DENTAL ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 215 N PITTSBURGH ST STE B | ||||||||
| Address2: | |||||||||
| City: | CONNELLSVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 154253209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7246288110 | ||||||||
| FaxNumber: | 7246288802 | ||||||||
| Practice Location | |||||||||
| Address1: | 215 NOTH PITTSBURGH STREET | ||||||||
| Address2: | SUITE B | ||||||||
| City: | CONNELLSVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 15425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7246288110 | ||||||||
| FaxNumber: | 7246288802 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2007 | ||||||||
| LastUpdateDate: | 05/29/2019 | ||||||||
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| AuthorizedOfficialLastName: | COPPETTI | ||||||||
| AuthorizedOfficialFirstName: | CONNI | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7246288110 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | Y | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist | General Practice |
No ID Information.