Provider Demographics
NPI:1518319953
Name:CHOPRA, SHRUTI (DDS)
Entity Type:Individual
Prefix:
First Name:SHRUTI
Middle Name:
Last Name:CHOPRA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 AMHERST PL
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA
Mailing Address - State:FL
Mailing Address - Zip Code:32081-0109
Mailing Address - Country:US
Mailing Address - Phone:678-650-4377
Mailing Address - Fax:
Practice Address - Street 1:9119 MERRILL RD STE 29
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-4306
Practice Address - Country:US
Practice Address - Phone:904-744-7202
Practice Address - Fax:904-744-8972
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 22071122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist