Provider Demographics
NPI:1225180235
Name:CHACHAD, ANU (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANU
Middle Name:
Last Name:CHACHAD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MRS
Other - First Name:ANU
Other - Middle Name:
Other - Last Name:DUCKWORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DENTIST
Mailing Address - Street 1:930 BEAUMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223
Mailing Address - Country:US
Mailing Address - Phone:951-845-2200
Mailing Address - Fax:951-845-9643
Practice Address - Street 1:930 BEAUMONT AVE
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223
Practice Address - Country:US
Practice Address - Phone:951-845-2200
Practice Address - Fax:951-845-9643
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA512371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9375101Medicaid