Provider Demographics
NPI:1275923047
Name:CHANDWANI DENTAL LLC
Entity Type:Organization
Organization Name:CHANDWANI DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIJESH
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANDWANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-529-0855
Mailing Address - Street 1:6918 KISSENA BLVD
Mailing Address - Street 2:UNIT 125A
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-1563
Mailing Address - Country:US
Mailing Address - Phone:203-529-0855
Mailing Address - Fax:347-494-4618
Practice Address - Street 1:6918 KISSENA BLVD
Practice Address - Street 2:UNIT 125A
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-1563
Practice Address - Country:US
Practice Address - Phone:203-529-0855
Practice Address - Fax:347-494-4618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-30
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty