Provider Demographics
NPI:1205403201
Name:CHU, NATHAN (DMD)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:CHU
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 1:960 LEARNING WAY #3400
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32306-0001
Mailing Address - Country:US
Mailing Address - Phone:321-480-1910
Mailing Address - Fax:
Practice Address - Street 1:960 LEARNING WAY #3400
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32306-0001
Practice Address - Country:US
Practice Address - Phone:321-480-1910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN25870122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist