Provider Demographics
NPI:1215250154
Name:NAVTEJ S TATLA DDS INC
Entity type:Organization
Organization Name:NAVTEJ S TATLA DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NAVTEJ
Authorized Official - Middle Name:S
Authorized Official - Last Name:TATLA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:530-891-1674
Mailing Address - Street 1:1046 MANGROVE AVE
Mailing Address - Street 2:SUITE-D
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-3548
Mailing Address - Country:US
Mailing Address - Phone:530-891-1674
Mailing Address - Fax:530-343-5757
Practice Address - Street 1:1046 MANGROVE AVE
Practice Address - Street 2:SUITE-D
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-3548
Practice Address - Country:US
Practice Address - Phone:530-891-1674
Practice Address - Fax:530-343-5757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-07
Last Update Date:2010-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA508301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA50830OtherSTATE DENTAL LISENCE