Provider Demographics
NPI:1457056665
Name:CHILMERAN DENTAL CORPORATION
Entity type:Organization
Organization Name:CHILMERAN DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DDS
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:MUNA
Authorized Official - Last Name:CHILMERAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-573-4889
Mailing Address - Street 1:PO BOX 920050
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75392-0050
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:575 CAMINO DE LA REINA STE 100
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3386
Practice Address - Country:US
Practice Address - Phone:619-573-4889
Practice Address - Fax:619-573-9359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-05
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty