Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | DN014100 | GA |
NPI | 1043466378 |
---|---|
Provider Name | Dr. Julio E Chinchilla |
First Address | Avondale Estates, GA 30002-1157 |
Second Address | Coppell, TX 75019-3297 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2008 |
Last Update Date | 07/09/2015 |