Provider Demographics
NPI:1003235763
Name:DUNCAN KACHALIA, CHARITY LUCILLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARITY
Middle Name:LUCILLE
Last Name:DUNCAN KACHALIA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1568 BANBURY DR
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582-5784
Mailing Address - Country:US
Mailing Address - Phone:925-362-8209
Mailing Address - Fax:925-362-0217
Practice Address - Street 1:525 BOLLINGER CANYON WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94582-4935
Practice Address - Country:US
Practice Address - Phone:925-362-8209
Practice Address - Fax:925-362-0217
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-10
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51574122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist