1841617438 NPI number — A. TINA CHANDRA, D.D.S., P.A.

Table of content: (NPI 1841617438)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841617438 NPI number — A. TINA CHANDRA, D.D.S., P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
A. TINA CHANDRA, D.D.S., P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841617438
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/24/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1920 SW 20TH PL
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
OCALA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34471-7881
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-861-1500
Provider Business Mailing Address Fax Number:
352-861-1507

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1920 SW 20TH PL
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
OCALA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34471-7881
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-861-1500
Provider Business Practice Location Address Fax Number:
352-861-1507
Provider Enumeration Date:
03/21/2014

Additional Information

Authorized Official

Authorized Official Last Name:
CUSTER
Authorized Official First Name:
RENEE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OFFICE ADMINISTRATOR
Authorized Official Telephone Number:
352-861-1500

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  DN14503 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1174669485 . This is a "NATIONAL PROVIDER IDENTIFICATION" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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