Provider Demographics
NPI:1396491809
Name:CHASE OAKS FAMILY DENTISTRY
Entity type:Organization
Organization Name:CHASE OAKS FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:DR
Authorized Official - First Name:LAVANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUDRAPATNA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:469-626-0131
Mailing Address - Street 1:280 LEGACY DR STE 105
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023-2314
Mailing Address - Country:US
Mailing Address - Phone:469-626-0131
Mailing Address - Fax:
Practice Address - Street 1:280 LEGACY DR STE 105
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-2314
Practice Address - Country:US
Practice Address - Phone:469-626-0131
Practice Address - Fax:972-867-4396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-23
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty