=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275853806
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHACHY REEMA PHILIP DMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2010
-----------------------------------------------------
Last Update Date | 06/05/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1064 E OSCEOLA PKWY
-----------------------------------------------------
City | KISSIMMEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34744-1607
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-932-2273
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1064 E OSCEOLA PKWY
-----------------------------------------------------
City | KISSIMMEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34744-1607
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-932-2273
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | DN19015
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------