Healthcare Provider Details

I. General information

NPI: 1235263278
Provider Name (Legal Business Name): ANDREW ROBERT CHAPOKAS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 07/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3730 3RD AVE
SAN DIEGO CA
92103-4112
US

IV. Provider business mailing address

3730 3RD AVE
SAN DIEGO CA
92103-4112
US

V. Phone/Fax

Practice location:
  • Phone: 619-297-2949
  • Fax:
Mailing address:
  • Phone: 619-297-2949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number58890
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number58890
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: