Provider Demographics
NPI:1285718593
Name:CHOMAS, DALE ROBERT (DMD)
Entity type:Individual
Prefix:
First Name:DALE
Middle Name:ROBERT
Last Name:CHOMAS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATSONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17777
Mailing Address - Country:US
Mailing Address - Phone:570-538-5533
Mailing Address - Fax:570-538-3182
Practice Address - Street 1:151 MAIN ST
Practice Address - Street 2:
Practice Address - City:WATSONTOWN
Practice Address - State:PA
Practice Address - Zip Code:17777-1706
Practice Address - Country:US
Practice Address - Phone:570-538-5533
Practice Address - Fax:570-538-3182
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026683L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice