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General NPI Number Information
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NPI Number | 1518319953
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Entity Type | Individual
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Provider Name | SHRUTI CHOPRA DDS
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Gender | Female
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Dates
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Enumeration Date | 07/11/2016
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Last Update Date | 07/11/2016
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Provider Practice Location Address
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Address Line | 9119 MERRILL RD STE 29
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City | JACKSONVILLE
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State | FL
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Zip | 32225-4306
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Country | US
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Telephone | 904-744-7202
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Fax | 904-744-8972
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Provider Business Mailing Address
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Address Line | 121 AMHERST PL
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City | PONTE VEDRA
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State | FL
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Zip | 32081-0109
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Country | US
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Telephone | 678-650-4377
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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 | DN 22071
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License Number State | FL
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