Healthcare Provider Details

I. General information

NPI: 1114022043
Provider Name (Legal Business Name): PRATHIMA CHAWLA DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 04/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2505 S BASCOM AVE
CAMPBELL CA
95008-4302
US

IV. Provider business mailing address

3247 FALLS CREEK PL
SAN JOSE CA
95135-2355
US

V. Phone/Fax

Practice location:
  • Phone: 720-987-6116
  • Fax:
Mailing address:
  • Phone: 720-987-6116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number63157
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8397
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: