Individual
JEMIMA CHATLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
100 E PETTIT AVE STE 1A, FORT WAYNE, IN 46806-3003
(260) 255-8269
Mailing address
2150 GLASTONBURY ROW # 3, FORT WAYNE, IN 46819-0002
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12014545A
IN
Other
Enumeration date
08/12/2024
Last updated
08/12/2024
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