Provider Demographics
NPI:1467638296
Name:CHAUDHRY, MUNIR A (DDS)
Entity Type:Individual
Prefix:DR
First Name:MUNIR
Middle Name:A
Last Name:CHAUDHRY
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 1:6719 W CAPITOL DR
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-2041
Mailing Address - Country:US
Mailing Address - Phone:414-464-6300
Mailing Address - Fax:414-464-2874
Practice Address - Street 1:6719 W CAPITOL DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-2041
Practice Address - Country:US
Practice Address - Phone:414-464-6300
Practice Address - Fax:414-464-2874
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-10
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI30041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33450800Medicaid