=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669731980
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VALUE DENTAL, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/07/2012
-----------------------------------------------------
Last Update Date | 05/07/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 110 N HIGHWAY 175
-----------------------------------------------------
City | SEAGOVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75159-1843
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-387-3498
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1110 SPINNAKER CT
-----------------------------------------------------
City | IRVING
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75063-5458
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROPRIETOR
-----------------------------------------------------
Name | DR. SURINA CHITKARA
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 469-387-3498
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 24909
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------