Healthcare Provider Details

I. General information

NPI: 1912983271
Provider Name (Legal Business Name): ROBERT T CHIARITO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 09/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4250 CERRILLOS RD #1202
SANTA FE NM
87507-4697
US

IV. Provider business mailing address

PO BOX 29476 4250 CERRILLOS RD #1202
SANTA FE NM
87592-9476
US

V. Phone/Fax

Practice location:
  • Phone: 505-982-4867
  • Fax: 505-424-8535
Mailing address:
  • Phone: 505-982-4867
  • Fax: 303-789-6040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDD2168
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: