Provider Demographics
NPI:1457490914
Name:TATLA, NAVTEJ
Entity Type:Individual
Prefix:DR
First Name:NAVTEJ
Middle Name:
Last Name:TATLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 PASEO HACIENDAS
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926
Mailing Address - Country:US
Mailing Address - Phone:530-894-9040
Mailing Address - Fax:714-571-3560
Practice Address - Street 1:2471 COHASSET RD
Practice Address - Street 2:SUITE #170
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-1315
Practice Address - Country:US
Practice Address - Phone:530-894-9040
Practice Address - Fax:530-894-9046
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50830122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD50830Medicaid