Provider Demographics
NPI:1043732480
Name:CHAWLA, JASON SINGH (DMD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:SINGH
Last Name:CHAWLA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 CAPISTRANO CT
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-0883
Mailing Address - Country:US
Mailing Address - Phone:985-774-8104
Mailing Address - Fax:
Practice Address - Street 1:600 N HIGHWAY 190 STE 4
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-5083
Practice Address - Country:US
Practice Address - Phone:985-893-5522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-07
Last Update Date:2017-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6790122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty