Healthcare Provider Details

I. General information

NPI: 1801858766
Provider Name (Legal Business Name): GURPREET CHATHA DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 WASHINGTON ST
TOMS RIVER NJ
08753-7643
US

IV. Provider business mailing address

16 WASHINGTON ST
TOMS RIVER NJ
08753-7643
US

V. Phone/Fax

Practice location:
  • Phone: 732-914-1039
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number022870
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: