1912983271 NPI number — ROBERT T CHIARITO DDS

Table of content: ROBERT T CHIARITO DDS (NPI 1912983271)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912983271 NPI number — ROBERT T CHIARITO DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHIARITO
Provider First Name:
ROBERT
Provider Middle Name:
T
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

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:
1912983271
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 29476
Provider Second Line Business Mailing Address:
4250 CERRILLOS RD #1202
Provider Business Mailing Address City Name:
SANTA FE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87592-9476
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-982-4867
Provider Business Mailing Address Fax Number:
303-789-6040

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4250 CERRILLOS RD
Provider Second Line Business Practice Location Address:
#1202
Provider Business Practice Location Address City Name:
SANTA FE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87507-4697
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-982-4867
Provider Business Practice Location Address Fax Number:
505-424-8535
Provider Enumeration Date:
12/19/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  DD2168 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 03827071 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: DD2168 . This is a "STATE LICENCE" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".




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