Provider Demographics
NPI:1265172605
Name:CHOTALIA, DHRUV S (DMD)
Entity type:Individual
Prefix:
First Name:DHRUV
Middle Name:S
Last Name:CHOTALIA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:837 WEDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-1836
Mailing Address - Country:US
Mailing Address - Phone:215-421-0357
Mailing Address - Fax:
Practice Address - Street 1:8 OMRS/SGXD UNIT 5022 (BLDG 409)
Practice Address - Street 2:KUNSAN AB
Practice Address - City:APO AP
Practice Address - State:PA
Practice Address - Zip Code:96264-5022
Practice Address - Country:US
Practice Address - Phone:215-421-0357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-01
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014179381223G0001X
171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No171000000XOther Service ProvidersMilitary Health Care Provider