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General NPI Number Information
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NPI Number | 1083502207
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Entity Type | Individual
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Provider Name | PRANAYAN CHAKMA DMD
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Gender | Male
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Dates
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Enumeration Date | 06/26/2025
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Last Update Date | 08/18/2025
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Provider Practice Location Address
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Address Line | 689 N ST
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City | FIREBAUGH
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State | CA
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Zip | 93622-2156
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Country | US
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Telephone | 559-659-3037
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Fax |
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Provider Business Mailing Address
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Address Line | 1441 WILLOW TREE LN
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-3658
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Country | US
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Telephone | 909-280-1347
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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 | 111785
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License Number State | CA
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