Provider Demographics
NPI:1699178657
Name:CHCL ORTHODONTICS LLC
Entity type:Organization
Organization Name:CHCL ORTHODONTICS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CESAR
Authorized Official - Middle Name:HUMBERTO
Authorized Official - Last Name:CARDENAS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-963-0083
Mailing Address - Street 1:842 DACULA RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-3185
Mailing Address - Country:US
Mailing Address - Phone:770-963-0083
Mailing Address - Fax:770-963-0084
Practice Address - Street 1:842 DACULA RD
Practice Address - Street 2:SUITE 102
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-3185
Practice Address - Country:US
Practice Address - Phone:770-963-0083
Practice Address - Fax:770-963-0084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-06
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty