Provider Demographics
NPI:1679788509
Name:CHAMORRO AGUIRRE, PATRICIA A (DMD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:A
Last Name:CHAMORRO AGUIRRE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:PATRICIA
Other - Middle Name:A
Other - Last Name:AGUIRRE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:8305 UNIVERSITY EXECUTIVE PARK DRIVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262
Mailing Address - Country:US
Mailing Address - Phone:704-547-1279
Mailing Address - Fax:704-547-8383
Practice Address - Street 1:900 W TRADE ST
Practice Address - Street 2:SUITE 120
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28202-1139
Practice Address - Country:US
Practice Address - Phone:704-332-9848
Practice Address - Fax:704-332-4545
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC77521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice