Provider Demographics
NPI:1376942748
Name:NAGARAJ, CHITRA (DMD)
Entity Type:Individual
Prefix:
First Name:CHITRA
Middle Name:
Last Name:NAGARAJ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38705 OAK PLACE CT
Mailing Address - Street 2:
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159-6059
Mailing Address - Country:US
Mailing Address - Phone:352-562-6224
Mailing Address - Fax:
Practice Address - Street 1:38705 OAK PLACE CT
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-6059
Practice Address - Country:US
Practice Address - Phone:352-562-6224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 207871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice