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General NPI Number Information
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NPI Number | 1093101263
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Entity Type | Individual
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Provider Name | MUDRIKA CHHABRA B.D.S.
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Gender | Female
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Dates
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Enumeration Date | 04/14/2015
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1720 S GADSDEN ST
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City | TALLAHASSEE
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State | FL
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Zip | 32301-5506
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Country | US
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Telephone | 850-521-5121
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Fax |
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Provider Business Mailing Address
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Address Line | 7990 LOCHKNOLL LN
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City | TALLAHASSEE
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State | FL
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Zip | 32312-6777
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Country | US
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Telephone | 850-691-7348
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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 | 9605
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DN22732
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License Number State | FL
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