Provider Demographics
NPI:1235541236
Name:SHAM CHANDOK
Entity Type:Organization
Organization Name:SHAM CHANDOK
Other - Org Name:CONSUMER DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHANDOK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:414-378-7971
Mailing Address - Street 1:5542 W FOND DU LAC AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-1200
Mailing Address - Country:US
Mailing Address - Phone:414-464-1070
Mailing Address - Fax:414-464-3797
Practice Address - Street 1:5542 W FOND DU LAC AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-1200
Practice Address - Country:US
Practice Address - Phone:414-464-1070
Practice Address - Fax:414-464-3797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-24
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3107-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1093974321OtherPROVIDER NPI NUMBER
WI1962569012OtherPROVIDER NPI NUMBER