Healthcare Provider Details

I. General information

NPI: 1285756361
Provider Name (Legal Business Name): ROBERT CHUONG DMD MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 12/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 16TH ST N
ST PETERSBURG FL
33704-3924
US

IV. Provider business mailing address

2140 16TH ST N
ST PETERSBURG FL
33704-3924
US

V. Phone/Fax

Practice location:
  • Phone: 727-894-1442
  • Fax:
Mailing address:
  • Phone: 727-894-1442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberME46866
License Number StateFL

VIII. Authorized Official

Name: DR. ROBERT CHUONG
Title or Position: PRESIDENT
Credential: M.D., D.M.D.
Phone: 727-894-1442