Provider Demographics
NPI:1215482047
Name:CHELIAN ORTHODONTICS
Entity type:Organization
Organization Name:CHELIAN ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHELIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:603-882-6100
Mailing Address - Street 1:36 CONANT ST
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-2954
Mailing Address - Country:US
Mailing Address - Phone:978-774-8266
Mailing Address - Fax:
Practice Address - Street 1:36 CONANT ST
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-2954
Practice Address - Country:US
Practice Address - Phone:978-774-8266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-22
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA36251223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH11-94911289Medicaid