Provider Demographics
NPI:1407402175
Name:BASYAL ACHARYA, CHANDANI (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHANDANI
Middle Name:
Last Name:BASYAL ACHARYA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 S LANSDOWNE AVE APT D7
Mailing Address - Street 2:
Mailing Address - City:YEADON
Mailing Address - State:PA
Mailing Address - Zip Code:19050-2423
Mailing Address - Country:US
Mailing Address - Phone:970-584-0084
Mailing Address - Fax:
Practice Address - Street 1:6412 FRANKFORD AVE # 10
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19135-3005
Practice Address - Country:US
Practice Address - Phone:215-792-3055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-17
Last Update Date:2019-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0424061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice