MEDICARE: CHOUGULE DENTAL CARE LLC

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

General Provider Information

NPI Number	:	1982175170
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHOUGULE DENTAL CARE LLC

Provider Business Mailing Address
First Line	:	1741 GOLD HILL RD
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29708-8202
Country	:	US
Telephone Number	:	201-675-7256
Fax Number	:

Provider Business Practice Location Address
First Line	:	1741 GOLD HILL RD
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29708-8202
Country	:	US
Telephone Number	:	201-675-7256
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DENTIST
Name	:	PRIYA P CHOUGULE
Credential	:	DMD
Telephone Number	:	201-675-7256

Provider Enumeration Date	:	12/16/2018
Last Update Date	:	12/16/2018

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