Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 9605 | KY |
Y | 1223P0221X | Pediatric Dentist | DN22732 | FL |
NPI | 1093101263 |
---|---|
Provider Name | Dr. Mudrika Chhabra |
First Address | Tallahassee, FL 32312-6777 |
Second Address | Tallahassee, FL 32301-5506 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2015 |
Last Update Date | 17/03/2018 |