Provider Demographics
NPI:1770954240
Name:CHOPRA, JASMINE (DMD)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:CHOPRA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2060
Mailing Address - Country:US
Mailing Address - Phone:508-532-2200
Mailing Address - Fax:508-853-8593
Practice Address - Street 1:200 HIGH ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MA
Practice Address - Zip Code:01510-2556
Practice Address - Country:US
Practice Address - Phone:978-368-0340
Practice Address - Fax:978-368-1719
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-09
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI100121615122300000X
MADL1857367122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist