Healthcare Provider Details

I. General information

NPI: 1861801490
Provider Name (Legal Business Name): CESAR AUGUSTO CHILMAZA DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2014
Last Update Date: 10/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2868 OWL AVE
PALM HARBOR FL
34683-6440
US

IV. Provider business mailing address

2868 OWL AVE
PALM HARBOR FL
34683-6440
US

V. Phone/Fax

Practice location:
  • Phone: 954-675-3742
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number1000980
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN21058
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: