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General NPI Number Information
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NPI Number | 1003003781
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Entity Type | Individual
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Provider Name | SUPAK CHOTI DDS
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Gender | Female
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Dates
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Enumeration Date | 09/26/2007
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Last Update Date | 12/04/2012
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Provider Practice Location Address
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Address Line | 38096 HIGHWAY 299 E
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City | BURNEY
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State | CA
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Zip | 96013-9792
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Country | US
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Telephone | 530-410-5851
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Fax |
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Provider Business Mailing Address
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Address Line | 3671 FOOTHILL BLVD
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City | REDDING
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State | CA
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Zip | 96001-0616
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Country | US
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Telephone | 530-510-3077
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 56408
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License Number State | CA
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