Provider Demographics
NPI:1124140694
Name:CHOMIAK DENTAL ASSOCIATES
Entity type:Organization
Organization Name:CHOMIAK DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CONNI
Authorized Official - Middle Name:L
Authorized Official - Last Name:COPPETTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-628-8110
Mailing Address - Street 1:215 N PITTSBURGH ST STE B
Mailing Address - Street 2:
Mailing Address - City:CONNELLSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15425-3209
Mailing Address - Country:US
Mailing Address - Phone:724-628-8110
Mailing Address - Fax:724-628-8802
Practice Address - Street 1:215 NOTH PITTSBURGH STREET
Practice Address - Street 2:SUITE B
Practice Address - City:CONNELLSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15425
Practice Address - Country:US
Practice Address - Phone:724-628-8110
Practice Address - Fax:724-628-8802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty