Provider Demographics
NPI:1255687844
Name:CHHABRA, AJNEESH (DDS)
Entity Type:Individual
Prefix:
First Name:AJNEESH
Middle Name:
Last Name:CHHABRA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4017 N PRINCE ST
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-9705
Mailing Address - Country:US
Mailing Address - Phone:575-762-2757
Mailing Address - Fax:575-762-2759
Practice Address - Street 1:4017 N PRINCE ST
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-9705
Practice Address - Country:US
Practice Address - Phone:575-762-2757
Practice Address - Fax:575-762-2759
Is Sole Proprietor?:No
Enumeration Date:2012-08-01
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD37421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice