Provider Demographics
NPI:1447561485
Name:CHANDWANI, BRIJESH P (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRIJESH
Middle Name:P
Last Name:CHANDWANI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6918 KISSENA BLVD
Mailing Address - Street 2:125A
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-1563
Mailing Address - Country:US
Mailing Address - Phone:347-494-4618
Mailing Address - Fax:
Practice Address - Street 1:6918 KISSENA BLVD
Practice Address - Street 2:125A
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-1563
Practice Address - Country:US
Practice Address - Phone:347-494-4618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-24
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT10404122300000X, 1223G0001X
NY056482122300000X
MADN1855394122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist