Basic Information
Provider Information
NPI: 1225279862
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHOPRA
FirstName: PREETI
MiddleName: M
NamePrefix: DR.
NameSuffix:  
Credential: DDS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 22210
Address2:  
City: OAKLAND
State: CA
PostalCode: 946232210
CountryCode: US
TelephoneNumber: 5105354000
FaxNumber: 5105354225
Practice Location
Address1: 3050 E 16TH ST
Address2: SUITE # 114
City: OAKLAND
State: CA
PostalCode: 946012319
CountryCode: US
TelephoneNumber: 5105354700
FaxNumber: 5105354283
Other Information
ProviderEnumerationDate: 03/11/2009
LastUpdateDate: 08/28/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1223P0300X62331CAY Dental ProvidersDentistPeriodontics

No ID Information.


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