Provider Demographics
NPI:1003914078
Name:CHANDRA, CHARU S (DMD MDS)
Entity Type:Individual
Prefix:
First Name:CHARU
Middle Name:S
Last Name:CHANDRA
Suffix:
Gender:F
Credentials:DMD MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 SOUTH CLAY ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ZELIENOPLE
Mailing Address - State:PA
Mailing Address - Zip Code:16063
Mailing Address - Country:US
Mailing Address - Phone:724-453-0234
Mailing Address - Fax:724-453-0313
Practice Address - Street 1:222 SOUTH CLAY ST
Practice Address - Street 2:SUITE 102
Practice Address - City:ZELIENOPLE
Practice Address - State:PA
Practice Address - Zip Code:16063
Practice Address - Country:US
Practice Address - Phone:724-453-0234
Practice Address - Fax:724-453-0313
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS027784L1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics