Provider Demographics
NPI:1770355380
Name:CENTURY DENTAL GR LLC
Entity type:Organization
Organization Name:CENTURY DENTAL GR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREATING PROVIDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COREY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHMIL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:570-876-4488
Mailing Address - Street 1:696 SCRANTON CARBONDALE HWY
Mailing Address - Street 2:
Mailing Address - City:EYNON
Mailing Address - State:PA
Mailing Address - Zip Code:18403-1004
Mailing Address - Country:US
Mailing Address - Phone:570-876-4488
Mailing Address - Fax:
Practice Address - Street 1:1821 SANDERSON AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18509-1854
Practice Address - Country:US
Practice Address - Phone:570-346-2244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty