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General NPI Number Information
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NPI Number | 1285756361
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Entity Type | Organization
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Legal Business Name | ROBERT CHUONG DMD MD PA
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Dates
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Enumeration Date | 04/06/2007
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Last Update Date | 12/09/2011
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Provider Practice Location Address
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Address Line | 2140 16TH ST N
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City | ST PETERSBURG
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State | FL
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Zip | 33704-3924
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Country | US
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Telephone | 727-894-1442
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Fax |
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Provider Business Mailing Address
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Address Line | 2140 16TH ST N
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City | ST PETERSBURG
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State | FL
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Zip | 33704-3924
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Country | US
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Telephone | 727-894-1442
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT CHUONG
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Credential | M.D., D.M.D.
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Telephone | 727-894-1442
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | ME46866
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License Number State | FL
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