Provider Demographics
NPI:1871951715
Name:CHOPRA & TADRISSI PLLC
Entity type:Organization
Organization Name:CHOPRA & TADRISSI PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:TADRISSI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-541-7017
Mailing Address - Street 1:14135 BALLANTYNE CORPORATE PL
Mailing Address - Street 2:#215
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-3383
Mailing Address - Country:US
Mailing Address - Phone:704-541-7017
Mailing Address - Fax:
Practice Address - Street 1:14135 BALLANTYNE CORPORATE PL
Practice Address - Street 2:#215
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-3383
Practice Address - Country:US
Practice Address - Phone:704-541-7017
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-07
Last Update Date:2016-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC93771223E0200X
NC84851223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty