MEDICARE: DR. CHRIS MICHAEL NAHAT

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	1223G0001X	General Practice Dentistry	26984	FL

General Provider Information

NPI Number	:	1629707245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRIS MICHAEL NAHAT

Provider Business Mailing Address
First Line	:	1202 SE PORT ST LUCIE BLVD
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-5364
Country	:	US
Telephone Number	:	772-335-3088
Fax Number	:

Provider Business Practice Location Address
First Line	:	1202 SE PORT ST LUCIE BLVD
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-5364
Country	:	US
Telephone Number	:	772-335-3088
Fax Number	:

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

Provider Enumeration Date	:	06/08/2022
Last Update Date	:	06/08/2022

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