Provider Demographics
NPI:1437706116
Name:PANCHANI, CHANDRA S (DMD)
Entity Type:Individual
Prefix:
First Name:CHANDRA
Middle Name:S
Last Name:PANCHANI
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 1:134 BELVIDERE AVE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07882-1417
Mailing Address - Country:US
Mailing Address - Phone:908-835-3500
Mailing Address - Fax:
Practice Address - Street 1:134 BELVIDERE AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07882-1417
Practice Address - Country:US
Practice Address - Phone:908-835-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-19
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02766000122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program