MEDICARE: DR. JULIO E CHINCHILLA DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223E0200X	Endodontics	12207	TN
2	1223E0200X	Endodontics	DN014100	GA
3	1223E0200X	Endodontics	DE61453479	WA

General Provider Information

NPI Number	:	1043466378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JULIO E CHINCHILLA DDS

Provider Business Mailing Address
First Line	:	195 14TH ST NE UNIT 2401
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30309-2678
Country	:	US
Telephone Number	:	310-740-6849
Fax Number	:	754-323-4385

Provider Business Practice Location Address
First Line	:	16810 MERIDIAN E STE J107
Second Line	:
City	:	PUYALLUP
State	:	WA
Zip	:	98375-9604
Country	:	US
Telephone Number	:	253-848-7777
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2008
Last Update Date	:	08/31/2023

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