Provider Demographics
NPI:1134289358
Name:CHANDRASHEKAR, SOWMYA (DDS)
Entity Type:Individual
Prefix:DR
First Name:SOWMYA
Middle Name:
Last Name:CHANDRASHEKAR
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 1:3614 FLORA VISTA AVE
Mailing Address - Street 2:APT # 168
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-3531
Mailing Address - Country:US
Mailing Address - Phone:408-802-3383
Mailing Address - Fax:
Practice Address - Street 1:3055 MOWRY AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536
Practice Address - Country:US
Practice Address - Phone:510-494-9000
Practice Address - Fax:510-494-9868
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50225122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist