MEDICARE: MICHAEL A CHANATRY DDS PA

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	1223P0300X	Periodontics

General Provider Information

NPI Number	:	1942467345
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL A CHANATRY DDS PA

Provider Business Mailing Address
First Line	:	3595 CARDINAL POINT DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-5500
Country	:	US
Telephone Number	:	904-737-2040
Fax Number	:	904-737-2051

Provider Business Practice Location Address
First Line	:	3595 CARDINAL POINT DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-5500
Country	:	US
Telephone Number	:	904-737-2040
Fax Number	:	904-737-2051

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	DR. MICHAEL ALBERT CHANATRY
Credential	:	DDS
Telephone Number	:	904-737-2040

Provider Enumeration Date	:	05/22/2008
Last Update Date	:	05/22/2008

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