Provider Demographics
NPI:1912983271
Name:CHIARITO, ROBERT T (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:T
Last Name:CHIARITO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 29476
Mailing Address - Street 2:4250 CERRILLOS RD #1202
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87592-9476
Mailing Address - Country:US
Mailing Address - Phone:505-982-4867
Mailing Address - Fax:303-789-6040
Practice Address - Street 1:4250 CERRILLOS RD
Practice Address - Street 2:#1202
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-4697
Practice Address - Country:US
Practice Address - Phone:505-982-4867
Practice Address - Fax:505-424-8535
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD2168122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM03827071Medicaid
NMDD2168OtherSTATE LICENCE