MEDICARE: DR. CHETAN SURENDRA DAULAT 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	1223P0700X	Prosthodontics	12202	MD

General Provider Information

NPI Number	:	1851414197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHETAN SURENDRA DAULAT DDS

Provider Business Mailing Address
First Line	:	13731 LAKESIDE DR
Second Line	:
City	:	CLARKSVILLE
State	:	MD
Zip	:	21029-1346
Country	:	US
Telephone Number	:	443-398-5910
Fax Number	:

Provider Business Practice Location Address
First Line	:	5454 WISCONSIN AVE STE 1500
Second Line	:
City	:	CHEVY CHASE
State	:	MD
Zip	:	20815-6922
Country	:	US
Telephone Number	:	301-652-9717
Fax Number	:	301-656-6708

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

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	03/15/2024

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