Provider Demographics
NPI:1982785747
Name:MUBASHIR A CHAUDHRY DMD PLLC
Entity type:Organization
Organization Name:MUBASHIR A CHAUDHRY DMD PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MUBASHIR
Authorized Official - Middle Name:A
Authorized Official - Last Name:CHAUDHRY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:407-898-5437
Mailing Address - Street 1:530 SPRING CLUB DR
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-5911
Mailing Address - Country:US
Mailing Address - Phone:407-758-8883
Mailing Address - Fax:407-228-9552
Practice Address - Street 1:907 OUTER RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32814-6653
Practice Address - Country:US
Practice Address - Phone:407-898-5437
Practice Address - Fax:407-228-9552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN137831223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty