Healthcare Provider Details

I. General information

NPI: 1215250154
Provider Name (Legal Business Name): NAVTEJ S TATLA DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2010
Last Update Date: 03/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1046 MANGROVE AVE SUITE-D
CHICO CA
95926-3548
US

IV. Provider business mailing address

1046 MANGROVE AVE SUITE-D
CHICO CA
95926-3548
US

V. Phone/Fax

Practice location:
  • Phone: 530-891-1674
  • Fax: 530-343-5757
Mailing address:
  • Phone: 530-891-1674
  • Fax: 530-343-5757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number50830
License Number StateCA

VIII. Authorized Official

Name: DR. NAVTEJ S TATLA
Title or Position: PRESIDENT
Credential: DDS
Phone: 530-891-1674