Provider Demographics
NPI:1578787909
Name:CHINTALA, MARK B (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:B
Last Name:CHINTALA
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 1:23676 SAN VICENTE RD
Mailing Address - Street 2:
Mailing Address - City:RAMONA
Mailing Address - State:CA
Mailing Address - Zip Code:92065-4245
Mailing Address - Country:US
Mailing Address - Phone:760-789-2882
Mailing Address - Fax:760-789-3752
Practice Address - Street 1:23676 SAN VICENTE RD
Practice Address - Street 2:
Practice Address - City:RAMONA
Practice Address - State:CA
Practice Address - Zip Code:92065-4245
Practice Address - Country:US
Practice Address - Phone:760-789-2882
Practice Address - Fax:760-789-3752
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADV0335621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice