MEDICARE: DR. LUIS ANTONIO CHAMORRO DMD, MPH

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	7743	NC

General Provider Information

NPI Number	:	1063414175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LUIS ANTONIO CHAMORRO DMD, MPH

Provider Business Mailing Address
First Line	:	11535 CARMEL COMMONS BLVD
Second Line	:	STE 205
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-5314
Country	:	US
Telephone Number	:	704-341-3636
Fax Number	:	704-341-3880

Provider Business Practice Location Address
First Line	:	11535 CARMEL COMMONS BLVD
Second Line	:	STE 205
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-5314
Country	:	US
Telephone Number	:	704-341-3636
Fax Number	:	704-341-3880

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	07/08/2007

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