Provider Demographics
NPI:1588324289
Name:CHATHAM DENTAL BOUTIQUE
Entity type:Organization
Organization Name:CHATHAM DENTAL BOUTIQUE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RAMNIK
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:415-994-3345
Mailing Address - Street 1:111 RIVEREDGE DR
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07928-3119
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:466 SOUTHERN BLVD
Practice Address - Street 2:ADAMS BUILDING, FIRST FLOOR (LEFT SIDE)
Practice Address - City:CHATHAM
Practice Address - State:NJ
Practice Address - Zip Code:07928
Practice Address - Country:US
Practice Address - Phone:415-994-3345
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-21
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental