Provider Demographics
NPI:1619175957
Name:CHOUGULE, PRIYA P (DMD)
Entity Type:Individual
Prefix:DR
First Name:PRIYA
Middle Name:P
Last Name:CHOUGULE
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 1:1741 GOLD HILL RD
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-8202
Mailing Address - Country:US
Mailing Address - Phone:803-548-3342
Mailing Address - Fax:803-548-3817
Practice Address - Street 1:1741 GOLD HILL RD
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-8202
Practice Address - Country:US
Practice Address - Phone:803-548-3342
Practice Address - Fax:803-548-3817
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-09
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9259122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist