Provider Demographics
NPI:1619190774
Name:CHAHAL, MANPREET K (DMD)
Entity type:Individual
Prefix:DR
First Name:MANPREET
Middle Name:K
Last Name:CHAHAL
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 1:175 W. VAN RIPER RD.
Mailing Address - Street 2:BOX 978
Mailing Address - City:FOWLERVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48836
Mailing Address - Country:US
Mailing Address - Phone:517-223-3779
Mailing Address - Fax:517-223-0452
Practice Address - Street 1:175 W. VAN RIPER RD.
Practice Address - Street 2:BOX 978
Practice Address - City:FOWLERVILLE
Practice Address - State:MI
Practice Address - Zip Code:48836
Practice Address - Country:US
Practice Address - Phone:517-223-3779
Practice Address - Fax:517-223-0452
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010183901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice