Healthcare Provider Details

I. General information

NPI: 1891831517
Provider Name (Legal Business Name): TONY G CHAMMAS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7910 FROST ST STE 160
SAN DIEGO CA
92123-2771
US

IV. Provider business mailing address

7910 FROST ST STE 160
SAN DIEGO CA
92123-2771
US

V. Phone/Fax

Practice location:
  • Phone: 858-576-2040
  • Fax:
Mailing address:
  • Phone: 858-576-2040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number44575
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: