Provider Demographics
NPI:1285756361
Name:ROBERT CHUONG DMD MD PA
Entity type:Organization
Organization Name:ROBERT CHUONG DMD MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DMD
Authorized Official - Phone:727-894-1442
Mailing Address - Street 1:2140 16TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33704-3924
Mailing Address - Country:US
Mailing Address - Phone:727-894-1442
Mailing Address - Fax:
Practice Address - Street 1:2140 16TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33704-3924
Practice Address - Country:US
Practice Address - Phone:727-894-1442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME46866204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL84866OtherBLUE CROSS BLUE SHIELD
FL240631OtherAVMED
FL17804OtherWELLCARE
FL2139383OtherAETNA
FL042348300Medicaid
FL240631OtherAVMED
FL2139383OtherAETNA
FL042348300Medicaid