Provider Demographics
NPI:1104143478
Name:COSMOPOLITAN DENTAL, LLC
Entity type:Organization
Organization Name:COSMOPOLITAN DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:W
Authorized Official - Last Name:CHEW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:856-983-2983
Mailing Address - Street 1:10000 LINCOLN DR E
Mailing Address - Street 2:SUITE 106
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3105
Mailing Address - Country:US
Mailing Address - Phone:856-983-2983
Mailing Address - Fax:
Practice Address - Street 1:10000 LINCOLN DR E
Practice Address - Street 2:SUITE 106
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-3105
Practice Address - Country:US
Practice Address - Phone:856-983-2983
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-27
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI01749700122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty