Provider Demographics
NPI:1104079789
Name:CHATAHAM DENTAL CARE LLC
Entity type:Organization
Organization Name:CHATAHAM DENTAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:J
Authorized Official - Last Name:SIMONOW
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:860-267-4900
Mailing Address - Street 1:PO BOX 281
Mailing Address - Street 2:
Mailing Address - City:EAST HAMPTON
Mailing Address - State:CT
Mailing Address - Zip Code:06424-0281
Mailing Address - Country:US
Mailing Address - Phone:860-267-4900
Mailing Address - Fax:860-267-7742
Practice Address - Street 1:33 W HIGH ST
Practice Address - Street 2:
Practice Address - City:EAST HAMPTON
Practice Address - State:CT
Practice Address - Zip Code:06424-1088
Practice Address - Country:US
Practice Address - Phone:860-267-4900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0083501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty