Individual provider Active NPI

Chitra Nagaraj, DMD

  • General Practice Dentistry
  • Lady Lake, FL
National Provider Identifier
1376942748
Registry record updated Aug 21, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN 20787 Issued in FL
Practice address
38705 Oak Place CT
Lady Lake, FL 32159-6059
Phone
(352) 562-6224
NPI assigned
Aug 21, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 21, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DN 20787 FL Primary

Addresses

Primary practice location

38705 Oak Place CT
Lady Lake, FL 32159-6059

Mailing address

38705 Oak Place CT
Lady Lake, FL 32159-6059
Phone (352) 562-6224

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180423002371 FL Order and Referring Only - DentistPractitioner - Dentist 8426311523

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DN 20787FLMDGeneral Practice Dentistry

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1408579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1408579200000",
    "number": "1376942748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "38705 OAK PLACE CT",
            "city": "LADY LAKE",
            "state": "FL",
            "postal_code": "321596059",
            "telephone_number": "352-562-6224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "38705 OAK PLACE CT",
            "city": "LADY LAKE",
            "state": "FL",
            "postal_code": "321596059",
            "telephone_number": "352-562-6224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NAGARAJ",
        "first_name": "CHITRA",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-08-21",
        "last_updated": "2014-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN 20787",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lady Lake, FL

Sources for this page

Verify at the official NPI Registry.