Provider Demographics
NPI:1134764814
Name:DEEPTI CHITTAL DMD PLLC
Entity type:Organization
Organization Name:DEEPTI CHITTAL DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMEBER
Authorized Official - Prefix:
Authorized Official - First Name:DEEPTI
Authorized Official - Middle Name:
Authorized Official - Last Name:CHITTAL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:409-433-6462
Mailing Address - Street 1:3020 39TH ST
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642-5548
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3020 39TH ST
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-5548
Practice Address - Country:US
Practice Address - Phone:409-982-7827
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-17
Last Update Date:2019-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental