Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 28209 | TX |
NPI | 1114165685 |
---|---|
Provider Name | Joshua Roland Chapa |
First Address | Austin, TX 78756-3331 |
Second Address | Austin, TX 78756-3331 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/01/2009 |
Last Update Date | 23/07/2020 |