Provider Demographics
NPI:1467580746
Name:BOOLCHANDANI, MOHAN K (DDS)
Entity Type:Individual
Prefix:DR
First Name:MOHAN
Middle Name:K
Last Name:BOOLCHANDANI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 S WILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:12095-2312
Mailing Address - Country:US
Mailing Address - Phone:518-762-8860
Mailing Address - Fax:518-762-8860
Practice Address - Street 1:7 S WILLIAM ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:NY
Practice Address - Zip Code:12095-2312
Practice Address - Country:US
Practice Address - Phone:518-762-8860
Practice Address - Fax:518-762-8860
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0368521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice