Provider Demographics
NPI:1093314668
Name:VENKATESH, CHANDAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHANDAN
Middle Name:
Last Name:VENKATESH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:193 WESTGATE DR
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-1164
Mailing Address - Country:US
Mailing Address - Phone:732-809-6688
Mailing Address - Fax:
Practice Address - Street 1:193 WESTGATE DR
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-1164
Practice Address - Country:US
Practice Address - Phone:732-809-6688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-23
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI028091001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice