Provider Demographics
NPI:1376244871
Name:CHANDIRAMANI ORTHO PLLC
Entity Type:Organization
Organization Name:CHANDIRAMANI ORTHO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANDIRAMANI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:502-396-2439
Mailing Address - Street 1:11838 LAKESTONE WAY
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:KY
Mailing Address - Zip Code:40059-9000
Mailing Address - Country:US
Mailing Address - Phone:502-396-2439
Mailing Address - Fax:
Practice Address - Street 1:10639 MEETING ST UNIT 101
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:KY
Practice Address - Zip Code:40059-6503
Practice Address - Country:US
Practice Address - Phone:502-396-2439
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty